foramen magnum meningioma
There were headaches. There was a large tumor on the brainstem. There was prayer. And there were hiccups that wouldn't quit.
But in the end, there would be one very happy, athletic, hard-working man named Dwight, who successfully underwent surgery for a large meningioma that was markedly pressing on his brainstem. Dwight is back at work full-time and back to helping his wife, Erica, nurture their large family.
Dwight's symptoms first appeared as headaches and a stiff neck that was most severe after he first got up. "The headache mainly happened during the morning," Dwight says. "Then, after I went to work or exercised, it would go away."
Dwight went to see a doctor, who prescribed medication for what appeared to be migraine headaches. When the medication didn't work, Dwight says, "I knew something wasn't right."
He toughed it out for a few more months, and then his wife, Erica, decided he needed an MRI scan of the brain. The MRI said it all: a mass the size of a golf ball on the brainstem. Dwight was then referred to Dr. William Tobler, a Mayfield Clinic neurosurgeon who practices at The Christ Hospital.
Dr. Tobler has earned a reputation for being one of Cincinnati's finest neurosurgeons through excellence and innovation in minimally invasive spine surgery. But he is also an accomplished cranial surgeon. And in Dwight's case, he took on a challenging sub-specialty operation in the lower part of the skull, often referred to as the skull base.
Specifically, the tumor was a rare foramen magnum meningioma, meaning that it was located within the foramen magnum, the large opening in the occipital bone at the base of the skull. The tumor was benign, meaning it would not metastasize and spread. But because it was growing rapidly, and because of its location on the brainstem, it would eventually threaten Dwight's life if it went untreated.
Dwight and wife Erica with Dr. Tobler
Dr. Tobler and Dwight talked about the risks of surgery, which were significant, because the tumor Dr. Tobler would remove was stretching multiple nerves that control breathing and swallowing.
During the 6-hour surgery, a posterior fossa craniotomy, Dr. Tobler approached the tumor through a three-inch incision. He removed the uppermost lamina of the first cervical vertebra as well as a small amount of the adjacent skull bone. "The tumor was so large and visible on exposure that I did not need image guidance," Dr. Tobler says. "This type of meningioma in this location is not very common."
The operation was successful, and the tumor was removed in its entirety. Dwight did experience a mini-stroke during the surgery, and he continues to lack sensation in his left shoulder.
Another complication involved the nerves in the brainstem that control swallowing, hiccups and other functions. "These nerves were stretched by the tumor," Dr. Tobler says. "As the tumor was carefully removed, these stretched nerves were carefully preserved and became 'un-stretched.' "
The resulting irritation, which was necessary, caused a hiccup reflex that lasted for several days.
"Obviously these nerves were irritated for a while, but they got better," Dr. Tobler says. "His entire compressed brainstem and tethered nerves went back into a normal position. Now those parts of his brain are happy!"
During Dwight's 17-day hospitalization, the Christ Emanuel Christian Fellowship rallied to support the family. Led by overseers Bishop Michael E. Dantley and Pastor Carol Dantley, church members cared for the family's children, helped with grocery shopping, provided back-to-school clothes and even presented Erica with a $400 grocery gift card. "They gave us strength to keep going," Dwight says.
Seven months after surgery, Dwight is back at work full-time and ready to resume the fitness regimen that has kept him fit and slim.
"Dr. Tobler is one of the best things that ever happened to us," Erica says. "He has been a blessing to our family."
Dwight says the experience has deepened his faith. "God woke me up, and my mission is to be accomplished."
Hope Story Disclaimer -"Dwight's Story" is about one patient's health-care experience. Please bear in mind that because every patient is unique, individual patients may respond to treatment in different ways. Results are influenced by many factors and may vary from patient to patient.
"The headache mainly happened during the morning," Dwight says. "Then, after I went to work or exercised, it would go away."
Anatomy of the Brain