"Thank you very much, Professor", Monica said standing next to Professor Bertalanffy. "I had to do it", Professor Bertalanffy said, giving a thumbs-up for their selfie. Standing next to them, Monica's mother was shining with infinite relief, just eleven days after the dangerous resection of her daughter's brainstem cavernoma. Just three months had passed since Monica's initial diagnosis of a brainstem cavernoma in September 2022 to their remote consultation with Professor Bertalanffy and finally to the surgery in November in Suzhou. Thanks to Professor Bertalanffy's expertise, Monica could get rid of her brainstem cavernoma. On the last day of the professor's 2022 round of surgical demonstrations, the immensely Monica wanted to get a picture with Professor Bertalanffy.
Pre- and post-operative images of Monica confirming the total resection of the cavernoma by Professor Bertalanffy
Medical history: Vomiting and dizziness without apparent cause. Subsequent examination revealed a cavernous hemangioma
Monica is a typical southern woman, even though she is already 35 years old, she still seems like a little girl next to her mother. The family is neither rich nor powerful, but they love each other, and everybody pulls their weight for the family to the best of their ability. Since she was very young, Monica was of poor health and had a weak sense of balance, often falling easily and even causing fractures at times. Because of that, the family had always been concerned about her health.
Then in September 2022, calamity struck out of nowhere. When Monica woke up from a nap, she had an unusual headache. It improved after a little rest, but the next day, even more severe symptoms manifested: dizziness, vomiting and unstable walk. Within one week, in addition to these symptoms, she also developed numbness in her left tongue, stiffness in her left cheek, and dizziness while sleeping. Seeing this abrupt development, Monica's family hurriedly brought her to the local hospital for a checkup. CT and MRI scans of her head showed shadows of high density in her left pons and left fourth ventricle as well as an old bleeding in the right cerebellum, suggestive of a cavernoma with a venous malformation.
Monica's symptoms were caused by a hemorrhage of this pontine cavernoma. After a cavernoma hemorrhaged a first time, it is impossible to predict when the second hemorrhage will occur. It can happen during exercise, at work, or during sleep... The medical histories of a majority of patients suggest that hemorrhages are not a one-time occurrence, but often happen repeatedly and irregularly. Every bleeding increases the chances of future re-bleedings and causes more severe symptoms. At some point, damage to neurological functions may be irreversible.
Monica's symptoms at this point were still relatively mild with numbness of the tongue and dizziness. But what about later? If one wants to completely eliminate the possibility of a future bleeding, then there is only one option - the save removal of the brainstem cavernoma.
The brainstem is the control center of the human body, squeezed into the size of a thumb. There are only a handful of doctors who can safely operate on the brainstem. Careless manipulation during the surgery can easily lead to facial palsy or hemiplegia (paralysis of one side of the body), in the worst case, the patient might not leave the operating room alive. The local doctor informed the patient about the difficult location in the brainstem and the high risk of surgery.
Seeing her daughter may develop unbearable symptoms any time due to the brainstem cavernoma, they got anxious and started searching for solutions on the internet and asking around online patient groups. Just at that time, they stumbled upon the announcement for Professor Bertalanffy's 2022 round of surgical demonstrations in China. Monica's relatives read reports of the professor's previous visits to the country. They learned that one of the pioneers of brainstem surgery would visit the country in November, so the family immediately decided to consult with him about whether Monica could have the surgery in China.
Professor Bertalanffy’s evaluation: "I can achieve a 100% resection rate."
With the assistance of translators from INC, Monica asked Professor Bertalanffy questions related to the surgery via email. "Is now a good time for surgery?" "What is the estimated resection rate?" "What complications and risks are there?" "Can new neurological deficits occur after the surgery?"After studying Monica's case, Professor Bertalanffy quickly replied that "the best time for surgery is now" and "I can achieve a 100% resection rate." Professor Bertalanffy responded to several questions about the timing of surgery, resection rate, recurrence rate, post-operative complications, etc. via email.
Professor Bertalanffy's consultation letter
In a subsequent follow-up video conference, the professor emphasized that he could indeed achieve a total resection of the brainstem cavernoma with a very low risk of recurrence.
Professor Bertalanffy's demeanor gave the family great confidence. Monica's is a very ordinary family, they believe that the company of their loved ones is the most important thing in life. They were determined to find the best surgeon for their daughter, and Professor Bertalanffy was their best choice. After careful consideration, they decided to take the opportunity and apply for Professor Bertalanffy's 2022 round of surgical demonstrations.
Chinese and German experts working together
Pre-operative briefing
As Monica's chief surgeon, INC's Professor Bertalanffy carefully planned the surgery together with the local physicians and made all necessary preparations. One day before the surgery, Professor Bertalanffy briefed Monica and her family about the procedure.
Surgery
The surgery was performed with the team of the Suzhou Dushu Lake Hospital. During the procedure, Professor Bertalanffy employed decades of experience to dodge the variety of intracranial blood vessels and nerves located in the resection area. After sufficiently exposing Monica's brainstem cavernoma, he safely removed it.
Adjusting the Monica's skull clamp
Marking the incision
Explaining the procedure to the local surgeons
Professor Bertalanffy performing the surgery with the assistance of the local experts
The surgery was successfully completed, the patient's vital signs were stable throughout the procedure. On the second day after the surgery, the patient was released from the ICU without new neurological deficits. The brainstem cavernoma that had plagued Monica was finally gone.
Post-operative development
On the third post-operative day, Professor Bertalanffy visited Monica on the normal ward. She was conscious and could answer all of the professor's questions. He told Monica that the surgery was a success, that the brainstem cavernoma had been completely resected, and that Monica didn't need to worry but instead should sit up and walk around a little bit. Monica asked about the double vision after the surgery and why she now couldn't accurately point a finger to her nose. Professor Bertalanffy replied that these symptoms were transient and would recover gradually after a period of time.
On the eighth day, Professor Bertalanffy visited Monica again. She was in a good mood and even joked with the professor about her numb tongue that caused her trouble eating. Professor Bertalanffy was delighted to hear Monica's joking about nothing tasting good. Her double vision had already improved greatly, and Professor Bertalanffy said her vision would fully recover in two to three weeks.
On the eleventh day, the last day of the 2022 round of Professor Bertalanffy's demonstration surgeries, he visited again. Monica was already walking around independently. After one week of recovery, her transient double vision and inaccurate hand movement had improved significantly. Monica was so happy that she took our her mobile phone, got out of bed and took a photo with the professor.
Currently, three months have past since her surgery. Monica is recovering well, she already returned to her work and lives a normal life. With the brainstem cavernoma gone, this cheerful girl dodged a bullet. Now, with the love of her family, she can continue to live a happy life.
