Discoveries Magazine

Cedars-Sinai

Connected

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When Tony Tommasi had a seizure in 2004, a tennis-ball-sized tumor was found in his brain. His wife-to-be, Heather, knew where to turn. She’d been there before.

She does not recall which hit the ground first, her head or her body. The impact tore from her memory much of that day 20 years ago. She seems to remember that while mountain biking, helmetless, she encountered a sudden drop in terrain. But she did not expect a second one so soon. Thrown from her bike, Heather Tommasi plummeted to the trail—and later found herself with a concussion in a hospital.

Doctors released the 19-year-old that same night, but she was rushed back the next morning after suffering a seizure. Scans revealed a tumor in her brain. The surgeon’s attitude, curt and pessimistic, did nothing to calm her fears.

“He said, ‘You’ll probably lose motor skills and you might not be able to speak anymore,’” Heather recalls. “It was just terrible.”

But Heather’s grandmother, a psychologist, knew of the work of pioneering neurosurgeon Keith L. Black, MD. Heather’s family arranged a consultation.

“It was a Friday, and he said, ‘You’ll be fine. You’re just going to be sick for a while. We can’t use lasers or anything. We have to go in through the top of your head,’” Heather remembers. “We booked the surgery for the following Monday.”

The benign tumor, a colloid cyst, was growing in one of the chambers through which cerebrospinal fluid flows to bathe the brain and act as a protective cushion.

“In some patients, these tumors are associated with a syndrome called sudden death,” Dr. Black explains. An internationally renowned neurosurgeon and scientist, he is chairman of the Department of Neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai. He also holds the Ruth and Lawrence Harvey Chair in Neuroscience. “Even though patients may not have any symptoms, when they make very quick head movements or bend forward, the tumors can move and irritate the area around the third ventricle. We don’t know quite what the mechanism is, but these people can die suddenly.” The tumors can also affect short-term memory and block the fluid’s ability to exit the brain, causing pressure to build dangerously.

The day of the surgery, Dr. Black spared brain tissue by taking advantage of the space that exists between the left and right halves of the cerebrum. At the corridor’s base lies the corpus callosum, a thick bundle of nerve fibers by which the two hemispheres communicate.

“We sneaked down and made a little incision, about a half inch long, in the corpus callosum, which put us right at the third ventricle,” Dr. Black says. “We then used microscopic guidance to remove the tumor.”

With the tumor removed, Heather’s life slowly returned to normal. To help other patients, and to express her appreciation for the care she received, she undertook volunteer work at the Department of Neurosurgery. Eventually, she took a position at an Internet marketing company, where she met and fell in love with Tony, one of the firm’s founders.

Tony was with Heather when, in August 2004, he was struck by a seizure. Paramedics rushed him to the same small hospital where Heather’s tumor had been diagnosed 11 years earlier. A CT scan showed a large tumor in the left frontal lobe of Tony’s brain.

From left: Gabriella, Maximillian, Heather and Angelica Tommasi; Keith L. Black, MD; and Tony Tommasi.

From left: Gabriella, Maximillian, Heather and Angelica Tommasi; Keith L. Black, MD; and Tony Tommasi.

The accident that tossed Heather off the trail 20 years earlier actually put her on a path to save her future husband’s life. “I took his scan up to Dr. Black’s office really early the next morning,” Heather says, “and waited for them to open.”

Unlike Heather’s tumor, Tony’s was malignant. Surgery was scheduled right away.

“Because the tumor was dangerously close to areas controlling language, we had to be particularly careful to avoid injury to normal brain tissue,” says Dr. Black. “Tony was awakened during the operation so we could be sure his language skills remained intact. But tumors can regrow if any cells are left behind, so we also needed to take out the entire mass.”

Dr. Black was able to achieve what neurosurgeons call image-complete resection—all tumor cells visible with magnification and MRI scans were successfully removed. He says in-surgery imaging is crucial in brain tumor operations, especially because some highly malignant tumors invade healthy tissue; discerning the borders is impossible with the naked eye and difficult even with imaging devices.

To improve intraoperative visualization systems, Cedars-Sinai neurosurgeons began working with a major imaging technology company nearly 15 years ago and have since researched innovative ways to make tumor cells easier to see and remove. One device uses light to stimulate molecules in cells, and captures the response with sensitive optical equipment. A recent study adapts a galaxy-exploring ultraviolet camera to see if it can provide a real-time “metabolic map” to immediately “light up” tumor cells.

These imaging studies are part of major research efforts underway at the Maxine Dunitz Neurosurgical Institute to develop effective treatments for brain tumors. Important advances have already been made—in immunology, nano-medicine, stem cells—and translated into new, effective treatments for patients.

Tony and Heather married on August 6, 2006, and have since started a family. The couple continues to work together in Internet marketing and recently launched a venture that enables customers to “try on” clothing and accessories using a computer and webcam.

But last August, Tony suffered another seizure, and after again being transported to the small hospital’s emergency room—“I always end up there,” he says with a laugh—he quickly made his way back to Cedars-Sinai. The tumor had returned, but the new growth was very small and appeared to be a less-aggressive, lower-grade version than the original. Dr. Black removed it on September 25, 2012, and Tony started a new round of chemotherapy.

connected-3“Dr. Black is very optimistic about this round, and I’m going to try to keep him out of my brain as much as possible,” Tony says with characteristic optimism and humor. He adds that he had eight good years after the first surgery and treatment and now hopes to be “on the 15- or 20-year plan.”

Tony, who was a national swimming champion for his Texas high school, says he was blessed and fortunate to achieve early success in business. Now he has a slightly different focus: Gabriella, 7; Maximillian, 5; and Angelica, 4.

“I’m probably going to be more of a stay-at-home dad now,” he predicts. “Maybe I’ll be the guy taking them to soccer practice and swimming instead of going out and working. But we have the new venture and we have big plans. Everything’s going to be fine.”

A year has slipped by, and Tony’s prediction was right.

“We’re doing well, and Tony had another clear MRI this week,” says Heather. “I feel fortunate that I was able to bring him to Dr. Black. We have an amazing bond with him and his team because of what we’ve been through.”

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One Response

  1. Salamehr dibaei says:

    I had a successful brain surgery with doctor black back in 2012 & this is what my son write after my operation.
    Seeing Dr. Black in action made me realize one simple and undeniable truth: it is the dedication of people like Dr. Black keeps the human spirit alive- no matter what your beliefs-at some level or other, the human existence would be lessened without special people like him. He had a great impact on us all during a very trying time & I never forget him for that. Every one please make sure to keep Dr. Black in your prayers. Amir D.

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