Unified Approach Restores Health and Hope for Young Dad After Rare Tumor Diagnosis

The day after he received his MRI results, Steve went to Brigham and Women’s Hospital to meet with neurosurgeon Omar Arnaout, MD, director of Clinical Neurosurgery at Mass General Brigham, and physician assistant Christine Moran, PA-C, and discuss his care plan. Their tremendous warmth and compassion immediately set the tone for his entire experience going forward, he said.  

“In that moment, I was really raw, vulnerable and anxious. Christine spoke to me like a mother would speak to a child, which sounds funny because I’m in my 40s, but I needed it at that time,” Steve remembered. “I told her outright, ‘I’m on the edge right now.’ She reemphasized that it was benign, spoke very slowly and looked at me directly the whole time. I just felt like she understood that I was a human in fear, and she took me from like a 90 to a 15 or 20.”

Dr. Arnaout’s calm, confidence and humanity further reassured Steve that he was in the best hands.

“He answered all the basic questions I had about the surgery and recovery, but he also saw me as a young father and talked about how he was a dad, too,” Steve said. “He was real about the possible risks, but said they were vanishingly small. And the verbatim quote he said next was, ‘You will go forth and be merry.’ As a lawyer, I appreciate that doctors need to go through the black-box warnings. As a patient, I was so grateful he talked to me like a human being.”  

It's an ethos that the whole team brings to every patient interaction, Moran said.

“This is such a turning point in people’s lives, so we take that seriously,” she said. “Even though it’s another day in the office for us, it’s not for them.”

Removing a vestibular schwannoma while preserving other functions requires extreme precision, Dr. Arnaout said. It requires microsurgery—surgery performed with specialized operating microscopes and instruments—as well as navigation systems and advanced intraoperative monitoring to minimize complications.

“Vestibular nerves that give rise to these tumors are running in a really, really tight corridor that spans a short distance from the brainstem to the ear canal, along with the nerves that controls hearing, facial movements, facial sensation and swallowing,” Dr. Arnaout explained. “There’s a lot of really important real estate in that area, plus a lot of blood vessels that feed the brain stem. Additionally, larger tumors can press on the brain stem, which is what was happening to Steve.”

Having a highly experienced, multidisciplinary team is essential to achieving good outcomes, Dr. Arnaout added. Critically, Steve’s surgical team included Mass Eye and Ear surgeon Alicia Quesnel, MD, a neurotologist whose expertise is in conditions affecting the facial nerve and balance system. Neurotologists have highly specialized training in caring for complex ear and skull base disorders.

The close collaboration and partnership with colleagues at Mass Eye and Ear enables patients to reap the benefits of an integrated health system. 

“In addition to the otologists, Mass Eye and Ear has a whole team of facial nerve surgeons, which is not a common resource. So, if we have patients with facial nerve weakness—profound or minimal—there is a team who can do facial reanimation surgery if needed,” Dr. Arnaout said. “The same is true for hearing. If we can't preserve hearing, then the neuro-otology team has options, including cochlear and brainstem implants that can give people function back. It’s so much better for the patients to have this huge multidisciplinary collaboration, and it's just the cherry on top that these clinicians are the best of the best.”

Ultimately, the team removed nearly all of Steve’s tumor during his surgery in July. The team opted to leave a tiny part of the mass that was on his facial nerve, as cutting into it carried a high risk of facial paralysis. Shortly after his surgery, Steve had some temporary voice hoarseness and was connected with laryngeal surgeon Tiffiny Hron, MD, at Massachusetts General Hospital to address some issues with his speech and swallow muscles. That quick intervention helped speed his recovery. 

A few weeks after surgery, Steve experienced an unrelated heart issue and was diagnosed with supraventricular tachycardia, or SVT, a condition that causes a rapid heartbeat at rest. When he needed care, he knew exactly where he wanted to go: Mass General Brigham. After being evaluated by cardiac electrophysiologist Victor Nauffal, MD, MSc, at Mass General Brigham Heart and Vascular Institute, Steve underwent an SVT ablation procedure to treat the condition.

The only remaining symptom Steve has today is hearing loss in his affected ear, which is common in patients with large vestibular schwannomas. Otherwise, he’s back to living a normal life.

“The medical care for both surgeries was great, and I can’t say enough about not only the doctors and nurses but also the staff I met,” he said. “Drs. Arnaout and Quesnel came to the BWH lobby at 10 p.m. on a Friday, the day of surgery, to give my wife an update in person once the surgery ended, and they both checked on me more than once in the ICU and hospital rooms. I know they're busy with their own lives, personal and professional, so this said a lot. You can tell when someone is just going through the motions, and they both were the opposite.”