Spring/Summer 2009

Cavernous Malformations
Precise Surgery Reverses Paralyzing Effects
Of Large Vascular Lesion On The Brainstem

A cavernous malformation in the brainstem led to severe neurologic deterioration.
After the lesion was removed, the patient was able to return to an active lifestyle.
Djena Ross was an active, healthy mother until the summer of 2008, when she began suffering the crippling effects of a cavernous malformation in her brainstem. The vascular lesion had left her paralyzed. Neurosurgeons from Carolina Neurosurgery & Spine Associates performed delicate surgery to remove the malformation. Now, after rehabilitation, Djena has returned to an active lifestyle.

The First Signs
In July of 2008, Djena felt popping in the back of her head, and started experiencing numbness on the right side of her face, which then extended down to her fingertips. She developed a sudden headache, double vision, and severe dyscoordination. This led her to go to an urgent care center. When her symptoms continued, she went to the ER and was admitted to Carolinas Medical Center. An MRI confirmed she had a large brainstem cavernous malformation.

About Cavernous Malformations
Cavernous malformations are vascular lesions that can occur anywhere in the brain. They are generally well-defined, grossly visible lesions that can reach a significant size, and are not high-flow vascular lesions like aneurysms. Some patients with these lesions are asymptomatic and will never experience medical problems. Other patients present with headaches, seizures, or small parenchymal hemorrhages. If a cavernous malformation hemorrhages, it can produce neurologic deficit, seizures or death. In many people, however, there are incidental findings, with prevalence in the population thought to be approximately 0.5%.

MRI offers the most sensitive means of detecting a cavernous malformation. Surgery should be considered when patients present with recurrent hemorrhage, progressive neurologic deterioration, like Djena, or intractable epilepsy.

Evaluating Djena
Practice neurosurgeon, Hunter Dyer, M.D., evaluated Djena in the hospital. He was amazed at the unusual size of the lesion in her brainstem. He was also surprised by the extent of her neurologic deficit and knew that surgery was her best option for any type of recovery.

Patient Djena Ross
and Hunter Dyer, M.D.
“She was essentially quadriplegic with profound difficulty moving her eyes. We certainly were very concerned about how much of the brainstem was involved,” said Dr. Dyer. “We were hopeful that we could find a safe zone to approach and remove this lesion without causing additional damage.”

Djena was transferred to physical rehabilitation to see if her neurologic status could progress further prior to surgery. While undergoing rehabilitation, Djena showed a determined will and an incredible attitude. “She never gave up, and I think ultimately, it even gave us, as her surgeons, more confidence,” said Dr. Dyer.After one month of rehabilitation, Dr. Dyer and practice neurosurgeon Martin Henegar, M.D., removed the cavernous malformation in a four-hour surgery. They were very pleased when they saw Djena move all her extremities in the recovery room. After the procedure, she initially had slurred speech, couldn’t eat anything and had short-term memory loss. Djena stayed in the hospital for two months and underwent speech and occupational therapy. For two weeks after she returned home, she had a home health nurse assist in her recovery.

“Considering her condition, Djena made dramatic improvement during the months after her surgery,” said Dr. Dyer. “She was able to drive again in November, and went back to work in December. This case is a prime example of how surgical expertise, rehabilitation, and patient determination combined to deliver a remarkable outcome.”

For more information about brain disorders and treatments, call 704-376-1605.

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