'Eyelid' removal of brain tumor apparently a success

Times photo by LUCY SCHALY David Barsottini from Big Beaver found out he had a brain tumor pressing on his retinas when he couldn't see out of his left eye. Doctors told him the tumor, the size of a small tangerine, had been lodged in his brain for decades.

BIG BEAVER — Just before dawn Wednesday, David Barsottini arrived at Allegheny General Hospital in Pittsburgh.

A team of surgeons was to perform innovative “eyelid” incision surgery to take out a tangerine-size tumor from the frontal base of his brain.  

If all went all, as Barsottini and his wife, Diane, hoped, some vision would return in his left eye. The Big Beaver resident would still have his salt-and-pepper hair and beard, and in a short time, a happy 52-year-old face free of a telltale surgery scar. 

Diane would have her husband back.

Eighteen months ago, Diane said the affable guy who’s always been a bit of a procrastinator through three decades of marriage developed “a care-less” attitude about everything. Motivation plummeted. Apathy reigned. Barsottini took to watching TV and the grass grow.

“What’s wrong,” she’d ask.

“Nothing,” he’d answered.

The answer came to light about five weeks ago. On an early April morning, Barsottini woke up and couldn’t see well. Anything he looked at from his left eye was “pretty much black.” He still had vision, thankfully, in his right eye.

Within days and after an MRI scan, a local neurologist told him, “You have a brain tumor.” Barsottini felt faint. “The good news is that it’s a benign type of tumor.”

A week later, neurosurgeon Dr. Khaled M. Aziz, director of AGH’s Center for Complex Intracranial Surgery, told the Barsottinis that there was swelling in the brain around the slow-growing tumor. The tumor had to be removed. If not, Barsottini would continue to lose vision and his memory would be affected.

Aziz asked Diane questions about seizures, wobbliness and behavioral changes. No seizures. He’s always been wobbly, she said. She did note her husband’s lack of enthusiasm. Her “What’s wrong?” question had been answered.

On a glum, rainy Tuesday morning, less than 24 hours before the big cut was to begin, the Barsottinis worked hard to joke about the tumor, but neither could muster rah-rah enthusiasm about the impending surgery. They were, however, thankful that each doctor had said the word “benign.”

“That word is one hell of a relief,” Barsottini said.

And then he joked, “The good news is we’re getting this done before the new health care kicks in because who knows what the government will do once they’re involved.”

When told they had two options, the Barsottinis immediately knew that they wanted Aziz and Dr. Erik Happ, a neuro-ophthalmologist, to perform the right eyelid frontal orbital craniotomy resection of a skull base meningioma.

Barsottini wasn’t acquainted with the procedure’s complicated medical name. But after talking to the two surgeons he understood what an eyelid minicraniotomy is, that it’s less invasive than a traditional surgery, which involves a long forehead incision and that, if all went well, he’d be able to leave the hospital in several days.

“The less they have to screw around with my brain the better,” Barsottini said.

“This approach is super cosmetically and gives (Aziz) and myself better access and a better orientation,” Happ said.

Since 2007, Aziz said he and Happ have performed about 40 eyelid minicraniotomy procedures for tumors and aneurysms at AGH. He learned the eyelid brain surgery procedure while training at the University of Cincinnati Medical Center, the only other hospital in the United States that offers the procedure, he said. When he came to AGH, Aziz and Happ decided to work as a team.
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They focus on a specific group of patients.

“It’s for selective patients for selective tumors and selective types of aneurysms in the right location,” Happ, a neuro-ophthalmologist surgeon said.

Barsottini’s tumor, a meningioma which grew out of membranes that surround the brain, was the right size and in the right place, the surgeons said.

The surgery would be a two-step procedure.

Happ said he would make a 2-inch long incision in the crease of the right eyelid and the tissue lining the upper part of the eye socket bone, or orbital rim. He’ll retract the eyeball, then uncover the bare bone.

Aziz will drill and remove a small piece of the orbital rim bone to create a small opening. The neurosurgeon will then use a fine laser probe and a mini-ultrasonic aspirator to cut and remove the tumor.

The two surgeons will reinsert the small piece of bone with titanium plates and screws, then Happ will close the eyelid incision.

The surgery typically takes from five to seven hours but can vary because each surgery is different, Happ said.

The outcomes also vary. Many patients see better, but for many the vision doesn’t return, Happ said.

“(Barsottini) has a significant vision loss, more than likely associated with the tumor,” Happ said. “By removing it, we are hopeful that he may be able to regain some of the vision.”

Diane Barsottini got to see her sedated husband late Wednesday.

“His right eye looked like he went a couple of rounds with Mike Tyson,” she said.

Ice eased the red puffiness. Hearing doctors say the words “went well” and “doing well” calmed her frayed nerves. Son Brian, his wife, Rachel, daughter, Lacey and close family friends Ashley and Michelle shared her relief.

Surgery scheduled for 8 a.m. began at noon Wednesday. Seven hours later, it ended.

Aziz said he spent five of the hours removing all of the “very attached” tumor through the small “eyelid” opening. Radiation, he said, is a possibility.

By Thursday afternoon, Barsottini was talking well, joking and laughing in the hospital’s intensive care unit, his wife said.

That evening Aziz and Happ said it would be at least several weeks before they’d know whether Barsottini will regain vision in his left eye. Progress could be expected daily and up to a year, Aziz said.

On Saturday, Barsottini’s right eye was still swollen, but Aziz said he was starting to see light and recognize faces with his left eye, the neurosurgeon said.

Come Tuesday, the patient probably will be ready to go home, Aziz said.

And soon he’ll probably want to do more than watch the grass grow. The way the Barsottinis see it, a summer road trip across Pennsylvania would be a great idea.