Miami Patient Returns to Physically Challenging Work Two Weeks after Brain Surgery

Hemed Meshulam is a 46-year-old Miami man who has a wife, two young sons, and employees who count on him to be at his best every day. But Meshulam and his wife, Karin, became increasingly concerned when debilitating headaches and severe pressure in his forehead began to diminish his ability to work and accomplish everyday tasks.

Meshulam visited his primary doctor on two separate occasions and was diagnosed each time with ear infections. He was given prescriptions for antibiotics and pain medication and sent on his way. Meshulam's pain and pressure in his head continued to worsen, and he was taken to the emergency room under extreme distress.

Important Diagnosis

A 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 that the cyst is there until it causes problems or shows up on an MRI or CT scan.

When a colloid cyst grows, it blocks the passage of cerebrospinal fluid from the brain. This causes hydrocephalus, which is the increased accumulation of fluid within the ventricles of the brain. Once there is a build up of fluid in the brain, symptoms can include 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, MD 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. Complete cure can be achieved by surgically removing the entire cyst," said Dr. Figuereo. "Once 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. Traditional brain surgery is complicated and requires that a large area of the skull be temporarily removed while the neurosurgeon cuts through the brain to get to the cyst. There is a greater risk of complications, which includes seizures, memory deficits, stroke, bleeding, infections, and others. Patients tend to endure a long operative procedure followed by a long recuperation period.

To remove the cyst, Dr. Figuereo used a neuronavigation system as a guide to plan a direct path through the brain. Using a one-inch hole drilled in Meshulam's skull, Dr. Figuereo was able to direct the probe through the hole and lead it through the brain to the location of the cyst. He then punctured a hole in the cyst's membrane to suction the fluid out and once the cyst was emptied, the membrane was then removed in its entirety through the small hole in Meshulam's skull.

The Result

The procedure lasted approximately two and a half hours - as opposed 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. Left with only a small scar on his head, Meshulam was discharged from the hospital just two days after surgery feeling great and was even 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."

MEDIA CONTACTS:
DARDET PUBLIC RELATIONS
Christine Dardet, APR
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chris@dardetpr.com

Debbie Liebross
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dliebross@bellsouth.net