Tyler Martin Schmidt, DO (left)
Neurosurgical Resident at University of Rochester Medical Center
Gabrielle Santangelo (right)
Medical Student at University of Rochester Medical Center
Dr. Uzma Samadani’s initial reaction was not to operate. Lupe Galeno-Rodreguez was a 15-year-old girl who was already severely limited due to tumors growing on her spinal cord. Her right leg was almost useless; tasks as simple as tying her shoes had become impossible. Lupe had one tumor removed in 2014, but because of her age, follow-up radiation was not offered. But the tumor had come back — and multiplied. Resection of her recurrent tumors would require extensive, high-risk surgery with questionable benefit to the patient.
When Dr. Samadani met Lupe and her parents, Oscar Galeno Garcia and Teresa Galeno-Rodriguez, however, she reconsidered. “Looking at a film versus looking at a patient are very different things,” says Dr. Samandani. Witnessing the suffering of Lupe and her family from the disease, “how could I not offer her surgery,” she contemplated. For Lupe and her parents, the risks of the surgery were equal to the natural course of the disease; they were resolute in moving forward with surgery.
Dr. Samadani began to construct the surgical strategy. Initially, she planned to stage the operation into three separate procedures: two days to remove the tumors (four of the tumors were clustered together, and one was in another area of the spinal cord). The third and final day of surgery would be to fuse Lupe’s spine. At the request of Lupe and her parents, Dr. Samadani modified the plan: a back-to-back two day staged operation. Day one would be dedicated to removing four of the tumors with the spinal fusion occurring the next day. Dr. Samadani would remove the other tumor at a later date.
Day one began at 7:30 AM. Dr. Samadani and her chief resident set out to resect the four clustered tumors in the lower part of the spine. In one region, Lupe had already undergone surgery, and there were significant adhesions and scarring. Dr. Samadani battled to achieve complete removal of the tumor without further damaging Lupe’s nerves. In the sacrum, one tumor had invaded the nerve roots. Dr. Samadani was in uncharted territory. “I had never done a resection in that location before,” Dr. Samadani says.
At 11:00 PM on the first operative day, the four tumors were removed. Lupe’s vital signs were stable. As Dr. Samadani looked at the open wound, she decided to remove the fifth tumor instead of leaving it for a different day.
This tumor, near Lupe’ functional spinal cord, required a delicate approach. After hours of careful microscopic work, the final tumor was out. The patient was taken for a post-operative MRI which confirmed the complete removal of all five tumors. The operative team was tired but satisfied with what they had accomplished for Lupe. Dr. Samadani made her way home to sleep for a few hours before starting the final surgery at 7:30 AM.
Lupe was prone (on her stomach) for 18 hours during the first day of surgery. Of utmost importance was the surgical and anesthesia teams’ collaboration to develop a plan to minimize the risks from the prolonged prone positioning. They monitored Lupe’s intraocular and intracranial pressures, hemoglobin, sodium and fluid balance, and when possible, maintained the patient’s head higher than the heart.
After the second day of surgery, Lupe reported to Dr. Samadani “I can’t see.” Blindness is a dreaded complication of prolonged prone positioning and was one of the complications Dr. Samadani had feared. Fortunately, Lupe’s vision improved to normal within 24 hours.
Immediately postoperatively, Lupe was doing well with minimal pain and no apparent deficits from the prone positioning or the surgery. However, Dr. Samadani was waiting for confirmation that she had achieved what she and her team set out to do: giving Lupe a chance to function as a typical ninth grade girl. Five days after surgery, Lupe got out of bed and used the bathroom. This seemingly mundane milestone was a point of great joy for Dr. Samadani and her team. Such a simple task held promise for Lupe’s recovery. She underwent two weeks of intense inpatient rehabilitation and is now back at school and continues to be active.
Dr. Samadani provides the following advice for young neurosurgeons about cases like Lupe’s. “When you practice neurosurgery, you love cases like this because it is your chance to make a real difference for a person.” She added, “To have them trust you so much and think you can help them and you go and do it, you’re part of a miracle in their lives.”
We salute the work of Dr. Samadani, going the extra mile to create miracle cures for patients like Lupe Galeno-Rodreguez.