It's been a little more than a year since Ana Zelada, a 39-year-old mother of two, underwent surgery for one of the most aggressive types of malignant brain tumors known. When she first visited Brian Pikul, M.D., Director of Neurosurgical Trauma at Cedars-Sinai Medical Center's Maxine Dunitz Neurosurgical Institute, she was virtually carried into his office, because the tumor had left her partially paralyzed and unable to walk without falling. Today, she takes long walks in the park every day, cares for her two teenage children and says she could dance if she wanted to. To date, there is no evidence of a recurrence.
Ana's story began back in 1994 when she experienced a seizure. She saw her physician and was given medications to prevent convulsions. For a while, things seemed fine, but then in 1999 she began experiencing frequent headaches. She went back to her physician, who did a biopsy. The news, he told Ana, was not good. She had a large malignant brain tumor known as an oligodendroglioma. A member of the "glioma" family of brain tumors, it is typically one of the more aggressive types of tumors, and Ana's was already at a Grade 3 -- the fastest growing in its class. Worse, the doctor felt it was already too large to treated surgically. Instead, Ana was given radiation therapy in an effort to shrink the massive growth.
Initially the tumor did diminish in size, but then it came roaring back -- larger than ever. By then Ana's headaches were occurring daily -- and they were excruciating. Worse, she began dropping things and began falling when she tried to walk. She went back to the doctor who ordered an MRI. Surgery, he said, was the only option. Without it, she would die -- probably within three months. But, he cautioned, because of the location and type of the tumor, the surgery itself was extremely risky and could result in her being a "vegetable" for the rest of her life.
Frightened and confused, Ana was unsure of what to do. She and her husband discussed the situation at length. They went for a second opinion, which was also very discouraging. "I can't promise that you'll walk again after surgery, but I'll do my best," the doctor told her.
The couple returned home to think some more. "I didn't know what to do," Ana remembers now. "I certainly didn't want to die, but neither did I want to live as a vegetable."
"Please don't worry about that," her husband reassured her. "I'll take care of you here at home if it comes to that. Just have the surgery."
The delicate operation was scheduled for mid January at a hospital near her home, but then the day before it was to take place, a friend called her, very excited. The friend had been doing some online research and had come across an article about the innovative treatments and brain tumor research being led by Keith L. Black, M.D., Director of the Maxine Dunitz Neurosurgical Institute, and by Dr. Pikul. "You must see these doctors before you have surgery," her friend urged.
Ana called, and the next day had an appointment with Dr. Pikul. After reviewing her films and medical history, he scheduled surgery that same week.
Using "motor strip mapping" and "computer guided imagery" during the operation itself, the surgical team could precisely identify the tumor's location. By placing an EEG strip on the brain while the patient was asleep, the surgeons were able to measure brain wave activity, and know which areas to avoid.
The motor strip mapping, which was confirmed by the computer-guided imagery, showed that the tumor was located behind Ana's motor sensory area. This was good news, indeed, as it meant the neurosurgeons could safely remove all of the tumor without causing any damage to Ana's motor skills.
After the tumor was removed, small "Gliadel" wafers saturated with cancer-killing agents were inserted into the tumor site in an effort to destroy cancer cells that inevitably remain after removal of a tumor of this type.
In the recovery room after surgery, Dr. Pikul woke Ana up, urging her to try to move her legs. "I woke up and immediately felt much stronger on my left side," she remembers. "I had previously been very weak on that side, but even in the recovery room I had more strength once the tumor was gone."
Now, after six months of follow-up chemotherapy and a year of physical therapy, Ana says almost back to 100 percent. "Before the operation, one shoulder was noticeably higher than the other," she says. "Now to look at me, you wouldn't notice a difference. Their alignment isn't 100 percent yet, but it's much better."
Best of all, she can walk freely -- taking long walks each day in the park -- and is headache free. "After the surgery, I never had another headache," she says emphatically. "Never!"
On the one-year anniversary of her surgery, Ana returned for a check-up with Dr. Pikul. The MRI was clear -- no sign of an active tumor. Doctors will continue to monitor her, with follow-up MRI's every 3-4 months.
"It's a mesmerizing experience," says Dr. Pikul, "being able to help people with devastating illnesses. It's a wonderful feeling, and it makes you want to perform even more research. I just thank God that all of the pieces of what we try to do for patients worked for Ana. She couldn't be doing better."
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