A Benign Brain Tumor, a Malignant Tumor, a Love Story and a Doctor's Reassuring Presence
It started 19 years ago, long before the Southland couple met, when Heather, then 19, fell while mountain biking, suffering a concussion. She was treated at a community hospital and released but had a seizure the next morning and was rushed back to the facility, where doctors discovered she had a brain tumor.
"One of their brain surgeons saw me, and what he said was very scary: 'You'll probably lose motor skills and you might not be able to speak anymore.' It was just terrible," said Heather Tommasi, recalling the doctor's gruff bedside manner.
Fortunately, Heather's grandmother, a psychologist, was familiar with the work of Keith L. Black, MD, professor and chair of the Department of Neurosurgery at Cedars-Sinai. Heather's family arranged a consultation.
"It was a Friday, and he said, 'You'll be fine. You're just going to be sick for a while. We can't use lasers or anything. We have to go in through the top of your head.' We booked the surgery for the following Monday," said Heather, who suffered from a colloid cyst of the third ventricle, one of the chambers through which cerebrospinal fluid flows to bathe the brain.
According to Black, it is a benign tumor that can have life-threatening consequences.
"In some patients, this is associated with a syndrome called sudden death. Even though the patients may not have any symptoms, when they make very quick head movements or bend forward, the tumors can move and irritate the area around the third ventricle. We don't know quite what the mechanism is, but these people can suddenly die. The tumors also can affect short-term memory, and they can block the fluid's ability to get out of the brain, building up dangerous pressure," said Black, director of the Maxine Dunitz Neurosurgical Institute and the Johnnie L. Cochran Jr. Brain Tumor Center and the Ruth and Lawrence Harvey Chair in Neuroscience.
"To take these tumors out, we use a corridor to go between the left and right halves of the brain, where they are separated by a very thick membrane," Black added. "We can sneak down and make just a little incision, about a half inch long, in the area called the corpus callosum, which puts us right at the third ventricle. We then use microscopic guidance to remove the tumor."
Heather's surgery and recovery progressed according to plan, and she soon resumed her normal life. Ten years later, she went to work for an Internet marketing company, where she met, became friends with, and fell in love with Tony Tommasi, one of the founders. She was at his apartment in August 2004 when Tony had a seizure. She called paramedics, who took him to the hospital where her tumor had been diagnosed 11 years before.
When a CT scan revealed a golf-ball-size tumor in the left frontal lobe of Tony's brain, dangerously close to areas controlling language, Heather predicted that Tony would receive a visit from a blunt doctor with a gloomy prognosis. She was right. Fortunately, she already knew, as she describes him, a skilled, calming and reassuring neurosurgeon; she had even done volunteer work at Cedars-Sinai's Department of Neurosurgery as a way to help patients and to express her appreciation for the care she had received.
"We just adore him and his staff. They're amazing," she said. She collected Tony's scans and had them at Black's office when it opened in the morning.
Unlike Heather's tumor, Tony's was malignant, an aggressive grade III anaplastic oligodendroglioma. Black was able to remove the entire tumor visible under magnification and imaging — a key factor because tumors can regrow from any cells left behind. Tony was awake during the operation to be sure his language areas remained intact. He followed up with a course of chemotherapy pills and got into the routine of undergoing regular MRIs to detect any recurrence as early as possible.
Tony and Heather got married on Aug. 6, 2006, and now have three children. The couple continued to work together in Internet marketing and recently started a new venture that enables customers, using a computer and webcam, to "try on" clothing and accessories before buying.
But last August, Tony suffered another seizure, and after again being transported to the small hospital's emergency room — "I always end up there," he says with a laugh — he quickly made his way back to Cedars-Sinai. The tumor had returned, but fortunately, the new growth was very small. Even more fortunately, after Black removed it on Sept. 25 — again with "awake surgery" that protected Tony's language skills — it was found to be a less aggressive, lower-grade form than the original.
Noting that the first surgery and treatment gave him eight good years without recurrence of the aggressive tumor, Tony looks at this battle with characteristic humor. "I've had my second surgery and everything is positive and optimistic so far. I'm just going into the chemical phase to see if we can extend my life with the 15- or 20-year plan," he said. "Dr. Black is a man of few words, and he doesn't need to speak much. He's very optimistic about this round, and I'm going to try to keep him out of my brain as much as possible."