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In the summer of 2014, during her last months of pregnancy, Kaitlin Eppinger began experiencing severe headaches and migraines. Her OBGYN prescribed medication and the headaches gradually went away, but returned soon after the birth of her daughter. Again, she attributed them to the pregnancy and hormonal changes. When the headaches persisted, she had blood work done that revealed she had Lyme disease. She received treatment and started to feel better, but was still not 100%. Usually a very active person, especially in the summer months, she noticed a lack of energy along with some new symptoms; body tingling and blurred vision that would come and go. She thought these symptoms might be related to the Lyme disease, but in autumn of that year, her doctor suggested an MRI of her brain just to be safe, which was performed at her local hospital.
Kaitlin had started teaching a new school year in her kindergarten classroom, and was feeling overwhelmed and stressed, when normally a new year brought excitement. The day after the MRI, she received a phone call at school with her results; she was instructed to call her husband to drive her to the Emergency Department immediately, as a mass the size of an orange had been found in her brain.
Doctors explained that the mass was of an irregular shape and size, very large, and located near the middle of her head, near her frontal lobe. Based on the presentation, they were surprised to see that she was up, walking, talking, and able to work. She was immediately referred to Dr. Jennifer Moliterno Gunel, a neurosurgeon who specializes in the surgical treatment of brain tumors at Smilow Cancer Hospital.
“Upon meeting Dr. Moliterno I could tell she was a very caring person,” said Kaitlin. “She made my family and me feel at ease right away. I was in shock, so my husband asked most of the questions, but she took the time to listen and make sure we understood everything. We both felt very comfortable with her. She put it simply for us, ‘this is something that is not supposed to be there, and we are going to get it out.’ From that point on I trusted her completely.”
While reviewing Kaitlin’s MRI, Dr. Moliterno noticed a very small and subtle finding that had previously been overlooked at the outside hospital. “I was concerned that there was a large, possibly abnormal blood vessel supplying the deep portion of the tumor,” said Dr. Moliterno, “so I ordered a special test called a CT angiogram (CTA) that shoots dye into the blood vessels to be performed before her surgery.” The CTA revealed the tumor to not only have a robust blood supply, but an aneurysm, or a balloon out pouching of one of the main arteries feeding the tumor. According to Dr. Moliterno, aneurysms of blood vessels supplying tumors are exceptionally uncommon and can be acutely life threatening if not found.
“Most people we see are faced with either potentially dangerous diagnoses- an aneurysm or a tumor- Kaitlin was in the unique and dangerous predicament of having both, which is exceedingly rare,” said Dr. Moliterno. “The relationship of the aneurysm and the tumor was such that it would have been very difficult to gain control of the bleeding if it had been encountered during removal of the tumor.”
Dr. Moliterno immediately called upon her neurovascular colleagues, Drs. Murat Gunel and Charles Matouk for their input and expertise. Dr. Moliterno commented, “I knew Dr. Matouk would be able to treat the aneurysm by gluing the vessel shut from the inside prior to me removing the tumor, thereby substantially lowering the risk of bleeding."
At most hospitals, the procedure for gluing blood vessels and surgery for removing brain tumors are done in separate locations with separate teams and equipment, leaving time for the life threatening swelling of the brain to occur. Smilow is the only hospital in the state with an operating room that has both capabilities, namely an intra-operative angiogram, right in the operating suite where tumors are commonly removed. For someone like Kaitlin, it was the difference possibly between life and death. Dr. Matouk was able to successfully glue the blood vessel with the aneurysm shut and in the span of minutes, Dr. Moliterno was able to begin surgery. Had Kaitlin not been at Smilow and there had been a delay in between the two procedures, the outcome could have been very different.
Heading into surgery, Kaitlin brought with her a book of photos of her daughter. She wanted to be able to see her first thing when she woke up. Kaitlin’s surgery, with the treatment of the aneurysm, took over 10 hours and her family was updated the entire time. “Dr. Moliterno saw me as a person, not a cancer patient,” said Kaitlin. “I knew that she would get me better so that I could continue being a mother to my daughter.”
A specific diagnosis was not determined until neuropathologist, Dr. Anita Huttner, examined with the tumor. Kaitlin’s diagnosis was a rare type of brain tumor called hemangiopericytoma. Over 98% of the tumor was successfully removed, and Kaitlin received radiation treatments to kill the remaining portion.
“It is a delicate balance to remove as much of the tumor as safely possible,” said Dr. Moliterno. “We could not have asked for a better outcome. Having the intraoperative angiogram technology inside the operating suite is quite unique, and I for one am very glad Kaitlin was referred to Smilow. People don’t realize the capabilities that we have right here, that other centers don’t have. It saves lives, and Kaitlin is proof of that.”
Kaitlin was only in the hospital for a few days, which surprised everyone. She still has a long road ahead and will be monitored closely for any signs of a recurrence. Combining surgical expertise with state-of-the-art technology saved her life. She is now hiking, doing Yoga, running, and enjoying all the things she used to do. “Sometimes I have to remind myself that I had a brain tumor, and that maybe I should slow down some,” said Kaitlin. “But I don’t want to waste any time. The silver lining in all of this is I get to spend time with my daughter that I wouldn’t have had before. I am taking the time to get healthy and knowing Dr. Moliterno is there for me if I need her is a great comfort.”