Mary Ann Gunderman, a healthy 73-year old grandmother, was vacationing at the Cape last July, and enjoying one of her favorite pastimes – playing in the ocean waves. She misjudged one and it hit her in the back of her head. That night she suffered terrible shooting pains in her face. Pain that was not relieved by taking Tylenol.
Mary Ann recalled that a year earlier she had had an episode of a sharp pain, like a stabbing electric shock, going through her jaw. Thinking the problem had to do with her teeth, she saw her dentist who took x-rays but found nothing. Just as the pain had unexpectedly appeared, it also disappeared.
However, this time, by the second night after the wave incident, Mary Ann was in agony. At 2 AM she was pacing the floor in excruciating pain. She and her vacationing friends started calling dental offices in nearby Orleans. They finally reached one that agreed to see Mary Ann the next morning. The dentist performed a pulpotomy, taking out a portion of one of her teeth. Still in pain, Mary Ann returned home to Connecticut, where her dentist did a root canal, thinking that would solve the problem.
When the mysterious pain intensified during the middle of the night, Mary Ann went to her local hospital’s emergency room. The staff, after a quick examination, felt that she was ‘looking for drugs’ and sent her home. In the morning, Mary Ann saw an oral surgeon, who diagnosed trigeminal neuralgia. This chronic pain condition, which affects the nerve that carries sensation from the face to the brain, is sometimes triggered by a tumor. When an MRI found a tumor in her brain, Mary Ann was quickly referred to Dr. Jennifer Moliterno Gunel, Assistant Professor of Neurosurgery at Yale School of Medicine and a member of the Brain Tumor Program at Smilow Cancer Hospital at Yale-New Haven.
The Brain Tumor Program at Smilow has gained regional and national recognition for comprehensive evaluation and diagnosis of brain tumors, leading edge treatment options, thorough follow-up, and psychosocial support.
“At Smilow,” explained Mary Ann, “they did a battery of tests. Almost immediately, they diagnosed the problem – a large tumor in the base of my skull pushing on my fifth cranial (trigeminal) nerve, and pressing against my brain stem.”
“Dr. Moliterno explained every single thing to me. She showed me all the x-rays and scans and their results. She told me I needed surgery to remove the tumor. It was in a delicate area and she was very honest about potential complications. There was a 50/50 chance I could lose hearing in my left ear. Parts of my face could be permanently numb and weak. My eye, my swallowing, and my facial function could be affected.” Dr. Moliterno planned to take enough of the tumor away to relieve the pressure against the nerves and the brainstem, while trying to avoid major complications.
“Mary Ann had quite a significant problem. Not only was she in an extraordinary amount of pain and taking toxic levels of trigeminal neuralgia medication, but her tumor was relatively large for its location and compressing her brain stem. Additionally, it was involving several cranial nerves, particularly important for facial function and hearing,” Dr. Moliterno explained. “Surgery for skull base tumors such as hers can be particularly challenging given the intricate association between the tumor, nerves and the brainstem. Here at Smilow, we use very special monitoring techniques that allow us to carefully remove as much tumor as safely possible, while preserving function and relieving pain.”
“I don’t know why,” noted Mary Ann, “but after I met Dr. Moliterno and all the experts at Yale, I became very calm. She is warm and personal. She has the gift of inspiring so much confidence. The team was extremely professional, so different from the doctors I had seen previously. The group at Yale knew exactly what the problem was and what was needed to resolve it. I had suffered so much pain. I heaved a sigh of relief. Now I knew that I had found professionals that would do the best they could do for me. They made me feel hopeful. I was so grateful to Smilow Cancer Hospital for actually helping me at a point where I would rather have died than to live with that pain. I know why trigeminal neuralgia is called the ‘suicide disease’ … the pain is so unbearable.”
During the eight-hour operation, Dr. Moliterno skillfully removed nearly all of the tumor – a slow-growing benign meningioma - leaving only a very small piece on the face nerve to preserve its function. Mary Ann was up and about, walking without help on the second day. Four days after surgery she was able to go home. No additional treatment will be needed. Dr. Moliterno commented that another major accompishment was that they were able to preserve Mary Ann's hearing. Going in, they knew hearing loss was a concern, but Mary Ann will be able to hear her granchildren's voices for years to come, which was very important to her.
“The nursing staff at Smilow is wonderful,” said Mary Ann. “I can’t believe how quickly I recovered. The whole side of my face was numb after the operation, but each month it has gotten better and now the numbness is almost all gone. And I didn’t lose my hearing. I have had a really good success story. I have no pain. It’s just a miracle. And the team at Smilow is so pleased with the outcome.”
Mary Ann has been amazed by the great support she received from her family and her friends. “I’m a very independent person so this was an eye-opening experience for me. One minute you have your life and the next minute it’s all up in the air. I had to trust other people to take care of me,” said Mary Ann. “I have a wonderful family (five children and 16 grandchildren) and so many friends who were praying for me. I now realize that every day is a gift. We all go along making plans and then life happens. You think you’ve got it all under control, but all of a sudden everything changes. I’m so much less worried about everything. The dusting can wait. I’d rather go see my friends, take care of my garden and do things with my grandchildren.”