A complicated procedure gone right
Multidisciplinary team at UF Health Skull Base Center save a life in procedure done for first time in U.S.
Lauren Fells vividly recalls the angst from April 27, 2019, the date a life-threatening tumor started its wrath. She was sick at work that day and had been battling migraine headaches for weeks. A month or so later, Fells learned from the UF Health Skull Base Center that she had a brain tumor, requiring expert removal to help her survive.
Carol Milton, Fells’ niece, winced at the memory of seeing her aunt in pain. Milton and Fells are close in age. They are more like sisters, often finishing each other’s sentences and laughing at inside jokes. It was early June when Fells told her family she couldn’t take the pain any longer.
“My head was swollen and the pain was unbearable,” Fells said.
Fells put off going to the hospital due to the concern of paying for a potentially mystery diagnosis. What if one visit meant multiple visits? Expensive medications? Surgery? How would she pay for it without insurance?
The decision to seek treatment
Milton and DeVeisha Wesley, Fells’ granddaughter, talked to her about why UF Health Jacksonville was the best place, and Fells agreed to go to the emergency room. At the time, she had no idea how pivotal this decision would be.
At the emergency room, Fells waited as staff tried to help find answers. She was admitted, and an MRI revealed a large tumor fighting for space inside her head. This is when the team at the UF Health Skull Base Center got involved.
The center provides state-of-the-art care for the treatment of skull base and brain tumors and related conditions. Part of the largest neurosurgery practice in Northeast Florida and Southeast Georgia, the highly trained multidisciplinary team is led by neurosurgeon, Daryoush Tavanaiepour, MD. It is the only center of its kind in this region.
“The tumor was pushing against her brainstem, which caused issues with her balance,” Tavanaiepour said. “She had trouble walking when she arrived. And pressure was building because brain fluid could not circulate properly, resulting in headaches.”
The complex, groundbreaking procedure
A team of professionals with the UF Health Skull Base Center worked diligently to review Fells’ files, discussing test results and using their decadeslong combined neurological expertise to consider potential treatment options.
It became clear to the team that Fells’ case was both incredibly unique and complicated due to the location of the tumor. It was surrounded by critical structures of the brain, particularly the brainstem and arteries and vessels, making it more challenging than usual. Surgery on this location of the brain had only been performed once before, in Europe.
It’s common for patients with brain tumors to be given three potential options: monitor the tumor, perform surgery or receive radiation treatment. Due to the size and location of the tumor and the debilitating effect it was having on Fells’ life, Tavanaiepour recommended surgery. However, this complex procedure came with high risks, including the possibility of stroke, which Tavanaiepour explained carefully to Fells. His comforting bedside manner put her at ease.
“The way he spoke was very transparent,” Fells said with gratitude. “I was confident about the surgery. I trusted God, and I trusted the doctors.”
The case was discussed at tumor board, which comprised neuroradiology, proton therapy and other experts. It was unanimously agreed upon to proceed with surgical intervention.
The final decision to operate required all hands on deck. Working alongside Tavanaiepour were two accomplished UF Health Jacksonville neurosurgeons: Grzegorz Brzezicki, MD, PhD and Gazanfar Rahmathulla, MD; as well as Dinesh Rao, MD, the chief of neuroradiology.
“Dr. Brzezicki specializes in arteries and veins, so he came up with a plan for the venous channel that was blocking access to the tumor,” Tavanaiepour said. “Dr. Rahmathulla and I discussed how to take the tumor component out. At the same time, Dr. Rao examined MRI images to make sure we didn’t come across additional obstacles.”
A life saved
The surgery, which was performed in segments, was a success. First, Brzezicki and Tavanaiepour removed the vein, followed by Tavanaiepour and Rahmathulla resecting the tumor.
Tavanaiepour recalled with pride everyone who played a role in saving Fells’ life. He credits the entire team as being instrumental in the outcome, including the operating room staff, nurse practitioners, physician assistants and the recovery team. The successful removal of the tumor makes the UF Health Skull Base Center team the second group in the world to perform this complex procedure.
Several months afterward, Fells said she feels wonderful and has rededicated her life to serving the Lord. She still gets occasional headaches, which is normal, according to Tavanaiepour. Fells said she wants to encourage others to go to the hospital sooner rather than later when they’re in pain. She is glad she did.