Filling the House with Music Again
It was a dire and rare diagnosis — literally one in a million. Andrew had a colloid cyst in the third ventricle of the brain.
Andrew is normally an active and social high schooler. But in June 2020, while wrapping up his freshman year in high school, Andrew, then 15, began having severe headaches every other month — often accompanied by vomiting and vision changes. "Andrew is an outgoing kid, and these headaches were also dampening his ability to be his usual self," his mother said. She had experienced migraines and vomiting as a teenager herself and wondered if it was hereditary.
After another migraine in early January 2021, Andrew saw a neurologist near their northern New Jersey home a couple of weeks later. An MRI in late January showed that it was far worse than a migraine: there was a dangerous cyst in Andrew's brain that could be fatal at any time if it wasn't surgically removed immediately.
They were told to go straight to the emergency room of a local hospital to meet a pediatric neurosurgeon who would explain the situation and prepare for emergency neurosurgery. Andrew was admitted to the hospital's pediatric ICU. Seeking a same-day second opinion, the surgeon agreed to connect them with Neil Feldstein, MD, Director of Pediatric Neurological Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital — and Dr. Feldstein agreed that the surgery couldn't wait.
It was a dire and rare diagnosis — literally one in a million. Andrew had a colloid cyst in the third ventricle of the brain. The ventricles are cavities in the brain through which cerebrospinal fluid flows. The cyst was acting like a plug that prevented the third ventricle from draining, leading to a perilous build-up of fluid in the brain called hydrocephalus and greatly raising the pressure inside Andrew's head.
The cyst had to be removed as soon as possible. Such a diagnosis was rare for any pediatric neurosurgeon to see, and equally rare for a hospital team. His parents chose to have him transferred to a hospital with a pediatric neuro-ICU — a strength of both NewYork-Presbyterian Morgan Stanley and NewYork-Presbyterian Komansky Children's Hospital.
Dr. Feldstein collaborates closely with the pediatric neurosurgeons at NewYork-Presbyterian Komansky & Weill Cornell Medicine, and he told Andrew's parents that Mark Souweidane, MD, its Director of Pediatric Neurosurgery, could do the procedure using an endoscope — operating through a small incision rather than having to perform an "open-brain" craniotomy with a larger incision. Moreover, Dr. Souweidane had exceptional experience doing the procedure for this rare condition. "Dr. Feldstein said that if Andrew were his own child, he'd have Dr. Souweidane do the surgery," they recalled.
Between the expertise of a children’s hospital, the experience of Dr. Souweidane, and the lower risk of an endoscopic procedure, the family felt the choice for the care team was clear. Andrew was transferred by ambulance to the pediatric neuro-ICU at NewYork-Presbyterian Morgan Stanley on the evening of Monday, January 25, with surgery planned for the next day. Andrew was an active participant in his care, asking his doctors and nurses questions he had about what lay before him and telling his mom, "Don’t worry, I'm going to be ok."
Both surgeons rearranged their schedules. Dr. Feldstein coordinated Andrew's presurgical and postsurgical care, including repeat MRIs to plan the surgery, while Dr. Souweidane performed the procedure, with Dr. Feldstein by his side in the OR. "We were very impressed with how well the two surgeons from two different practices worked together," said Andrew’s father. Dr. Souweidane inserted a slender scope to reach the center of the head through a nickel-sized incision on the right top side of Andrew's forehead and removed the cyst during a three-hour operation.
Andrew, now 16, recovered in the pediatric neuro-ICU for a couple of days, moving to a step-down unit for a day before returning home on January 29. Upon arriving at home, he proudly announced, "See Mom, I told you I was going to be ok!" He had some issues with wound swelling and coming off dexamethasone treatment (a steroid used to control inflammation), which impaired his walking and led to joint pain. After being readmitted to the hospital to be sure there wasn’t a surgical complication and embarking on a longer period of weaning from the drug, he began feeling better. To his family’s delight, when he returned home from the hospital, he played piano daily, filling the house with music.
By the week of February 8, Andrew was able to listen to some of his virtual high school classes, returning to all his classes virtually by February 15 and back to in-person classes by the end of that week — just three and a half weeks after the operation. Thanks to the minimally invasive endoscopic approach, his recovery was far quicker than it would have been if he had conventional brain surgery. He also started gradual exercise and by early March, just six weeks after surgery, he went cross-country skiing with his family and started no-contact lacrosse practices with his high school team.
His 90-day imaging reflected the full success of the surgery. Dr. Souweidane gave Andrew clearance to return to all his normal activities, which included participating in the school band, full-contact lacrosse games, and riding roller coasters with his friends at the year-end school amusement park trip. He finished his sophomore year without any memory or learning issues, maintaining his strong academic performance. He looks forward to returning to varsity soccer in Fall 2021 and is enjoying something every teenager eagerly waits for: learning to drive, having gotten his learners' permit in June 2021.
Andrew’s parents were thrilled with the care he received. Said his mom, "We had a world-class team at NewYork-Presbyterian. They saved our son’s life.”