Focusing on patients part 4

Skull-base surgery team weaves tapestry of survival
(continued)

Cabral had never been to the UC Davis Medical Center for treatment. A life-long resident of Sacramento, she remembered when the old Sacramento County Hospital occupied the site on Stockton Boulevard where UC Davis has built its full-fledged, highly regarded academic medical center. But she was impressed by what she had heard and read about the hospital.

"When I saw Dr. Donald, I knew he was the miracle man. He was the guy they send you to when everything else has been tried," she said.

She was immediately told she would lose her right eye and that it was possible that her right carotid artery, which provides critically needed blood flow to the brain, might also be involved. With little time to lose and no wish to delay, she consented to the surgery to remove the tumor.

At 6 a.m. on Oct. 15 - the day after Cabral's 41st wedding anniversary - the skull-base surgery team convened in the operating room to begin the grueling 15-hour task.

Nemzek, an associate pro- fessor of neuroradiology and director of CT Scanning at UC Davis, had already performed a delicate balloon-test occlusion of Cabral's right carotid artery. With her awake, he had inserted and threaded a catheter into the artery, where a tiny balloon was inflated to block the blood flow. Because she was able to tolerate the occlusion without mani- festing stroke symptoms, the surgeons knew they would consider removing the artery if they found that her tumor had invaded it.

Pathologist Regina Gandour-Edwards analyzes dozens of interoperative biopsies in the course of one procedure so that the skull-base surgeons know when they have removed all the cancerous tissue.