Meshulam visited his primary doctor twice and was diagnosed each time with ear infections, given prescriptions for antibiotics and pain medication, and sent home. The debilitating pain and pressure in Meshulam’s head continued to worsen. One day he was taken to the emergency room because of the extreme distress. 

Important Diagnosis

A computed tomography (CT) scan of Meshulam’s brain showed an abnormality, which was diagnosed as a colloid cyst, a non-cancerous gelatinous mass that usually appears near the center of the brain. A person with a colloid cyst is typically born with it, but usually does not know the cyst is there until it causes problems or appears on a CT or magnetic resonance imaging (MRI) scan. 

When a colloid cyst grows, it blocks the passage of cerebrospinal fluid from the brain and causes hydrocephalus, which is an increased accumulation of fluid within the ventricles of the brain. This fluid buildup may cause symptoms, including headaches, pressure, nausea, vomiting, and/or confusion. Many times, colloid cysts are misdiagnosed as migraine headaches or ear infections because the symptoms are the same.

Meshulam was referred to internationally recognized neurological surgeon Santiago Figuereo, M.D. at the Miami Neurological Institute, a private practice specializing in minimally invasive surgeries for spine and brain disorders.

“Colloid cysts are non-cancerous lesions usually found in a hard-to-reach location. A complete cure can be achieved by surgically removing the entire cyst,” said Dr. Figuereo. “After the cyst has been completely removed, there is no chance of recurrence.” 

Minimally Invasive Treatment

Dr. Figuereo is one of a few neurological surgeons in South Florida who is fellowship trained to perform endoscopic, minimally invasive surgery for the removal of a colloid cyst. Endoscopy is a minimally invasive diagnostic medical procedure that is used to assess the interior surfaces of an organ by inserting a tube with a camera into the body. 

Prior to the innovation of this endoscopic approach, a patient with a colloid cyst would have to undergo traditional brain surgery for the removal of the cyst, which is complicated and requires the temporary removal of a large area of the skull while the neurosurgeon cuts through the brain to get to the cyst. There is a greater risk of complications with this traditional surgery, including seizures, memory deficits, stroke, bleeding, infections, and others. In addition, patients must endure a lengthy operative procedure followed by a long recuperation period.

Conversely, Dr. Figuereo used a neuronavigation system as a guide to plan a direct path through the brain to remove the cyst. Using a one-inch hole drilled into Meshulam’s skull, Dr. Figuereo directed the probe through the hole and into the brain to the location of the cyst. He then punctured a hole into the cyst’s membrane to suction the fluid out and, after the cyst was emptied, the membrane was removed in its entirety through the hole in Meshulam’s skull.

The Result

The procedure lasted approximately two and a half hours — compared to five or six hours for traditional surgery — and was a complete success. The postoperative images showed no residual cyst, and Meshulam’s preoperative symptoms disappeared. Two days after surgery he was discharged from the hospital with only a small scar on his head. Meshulam was able to return to work two weeks later.

“Sneaking through the brain with an endoscope to remove the mass caused minimal trauma to the brain, with very low risk for permanent changes, contrary to traditional open procedures,” said Dr. Figuereo.

Other than follow-up visits with Dr. Figuereo every two months, Meshulam will not have to worry about the chance of recurrence. 

“Dr. Figuereo thoroughly explained to us the condition and the procedure we were facing, which calmed our nerves a bit,” said Karin Meshulam. “Hemed is doing well — more than well, actually — and we are very thankful for that.”

For more information, visit www.miamini.com or call (786) 623-2000.

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About Santiago Figuereo, M.D.

Located in Miami and Fort Lauderdale, Fla., Miami Neurological Institute offers minimally invasive, state-of-the-art procedures for disorders of the brain and spine. The Institute’s founder and medical director, Santiago Figuereo, M.D., brings unique techniques to the region, including craniotomy with hair preservation, minimally invasive spinal discectomy, and minimally invasive endoscopic techniques for intracranial, skull base, and pituitary tumors. He is highly skilled in the surgical management of movement disorders, including deep brain stimulation for Parkinson’s disease and surgical procedures for epilepsy. 

Prior to arriving in South Florida, Dr. Figuereo served as standing faculty and assistant professor in the Department of Neurosurgery at the University of Pennsylvania School of Medicine and Neurosurgery Division Chief at the Philadelphia Veterans Administration Medical Center. 

Dr. Figuereo studied general surgery at the University of Pennsylvania and Graduate Hospital in Philadelphia and his neurological surgery residency was completed at Loma Linda University Medical Center. He completed a neurosurgery fellowship at the University of Washington and a fellowship in functional neurosurgery at the University of Pennsylvania.

For more information, visit www.miamini.com or call (786) 623-2000.