High School Hockey Player Recovers From Brain Tumor for Safe Return to the Ice

Hockey means everything to Aaron Merchand, a senior at Bellows Free Academy in St. Albans, Vermont. When a major shoulder injury ended his sophomore season early, he threw himself into physical therapy fiercely with one goal in mind: to get back on the ice by November.

In the spring of his junior year, he began having strange, unrelated symptoms. A watery right eye. Neck pain. And worst of all, daily headaches that kept him up at night.

Over the course of two months, Aaron saw several doctors, but no one could pinpoint the cause. Finally, he got an answer from Brigham and Women's Hospital neurosurgeon Omar Arnaout, MD: Aaron had a trigeminal schwannoma, a benign (noncancerous) brain tumor. This type of tumor represents between 0.1% and 0.4% of all tumors occurring within the skull.

"These are extremely rare tumors, but they're not rare for us at Mass General Brigham," Dr. Arnaout said. "We see patients with schwannomas every week, and we surgically remove at least one a week. Our team's experience was the main driver behind Aaron's positive outcome."

Misdiagnosis leads to weeks of uncertainty

After his symptoms began, Aaron saw several doctors. Eventually, a pediatric neurologist diagnosed him with a noncancerous brain tumor called a meningioma. However, Aaron's parents, Dan and Angie, still felt uneasy. They made an appointment with Dr. Arnaout on the recommendation of a friend whom he had treated for a brain tumor.

At that visit, Dr. Arnaout reviewed Aaron’s MRI and recognized the trigeminal schwannoma right away. Trigeminal schwannomas are noncancerous tumors that develop on the trigeminal nerve—the main nerve responsible for facial sensations and functions like chewing. The most common symptoms are facial numbness or tingling and headaches. Since they are so rare, these tumors are often misdiagnosed.

Schwannomas tend to grow very slowly. Keeping in mind Aaron's desire to play hockey again, Dr. Arnaout said it would be safe to take a "watchful waiting" approach—Aaron would come back for another scan in three months to see if the tumor had grown. This strategy is common with smaller tumors that are thought to be noncancerous and slow-growing and when symptoms are mild and stable.

"Close monitoring and being able to pivot quickly to definitive treatment are crucial," Dr. Arnaout said.

Dr. Arnaout's assistants Lizzie Kleynerman and Christine Moran always scheduled Aaron's appointments so that he could have an MRI done, meet with Dr. Arnaout, and return home with his family the same day. At the next visit, the MRI showed Aaron's tumor was growing faster than expected. Based on the pace of growth, Dr. Arnaout decided surgery would be needed to remove the tumor. The only question was how soon.

"Dr. Arnaout told us they'd continue to keep an eye on it, but they wanted to see if Aaron could get through hockey season and the academic year before having surgery," Dan said. "He stressed that they'd never let it get to the point where it would make surgery riskier."

Knowing surgery was definitely in Aaron's future led to many sleepless nights for Angie.

"I was a complete mess," she said. "The awesome thing about Dr. Arnaout is that he is honest, straightforward, and handles everything in a caring, calming manner. That helped a lot."

'We got it all out'

At a visit just before Thanksgiving, Aaron mentioned new symptoms: blurry vision and ear pain. Further testing showed the tumor had grown and was nearing the brain stem. Dr. Arnaout explained that he couldn't put off surgery any longer. His goal would be simple: remove the entire tumor, which could be curative if successful.

"You want to make the first surgery the last surgery, because things can get more complicated if you have to go in again," he said. "And having complete resection would offer him a chance at a cure and help get him back to hockey as quickly and safely as possible."

Surgery to remove a trigeminal schwannoma is a complex undertaking. The procedure can involve 10 to 15 people in the operating room and take eight or more hours to complete. In Aaron's case, it lasted six-and-a-half hours. Afterwards, Dr. Arnaout shared the good news with Dan and Angie.

"He told us, 'It's all good. We got it all out, and he’s doing great,'" Dan said.

"As soon as he said those words, I felt like I could breathe again," Angie added.

Aaron played a few more games before his team's season ended in the state semifinals. For now, he will have virtual follow-up visits with Dr. Arnaout every three months.

With graduation approaching, Aaron is looking forward to attending Merrimack College in the fall. He hopes club hockey will be part of his experience. 

The Merchands feel fortunate that Aaron was able to receive care from a skilled and compassionate Brigham and Women's team with highly specialized expertise in skull base tumors, including rare trigeminal schwannomas. And they are grateful that Dr. Arnaout was at the helm.

"He's just an amazing surgeon and human being," Angie said.

"The entire team, including Dr. Arnaout's physician assistants, is amazing, helpful, and caring," Aaron concluded. "They're always there when you need them."