Chaise Webber and his wife Maria Ramirez had just bought their first house. They needed the space: their 3-year-old son Aiden now had a 3-month-old sister, Isabella. These were exciting, if exhausting, times for a young family putting down roots in Colorado Springs. Then three seconds on a bench press machine threatened to change everything.
Webber, 27, who worked out five days a week, blacked out for those three seconds. Between that and the double vision and inexplicable fatigue after workdays as a corrections officer at the Spring Creek Youth Detention Center, it seemed that something deeper was going on than the sinus infection his primary care doctor had diagnosed. It didn’t take UCHealth neurosurgeon Dr. Thomas Ridder of the UCHealth Brain and Spine Clinic – Colorado Springs much longer than three seconds with Webber’s MRI images to see what the problem really was: a rare brain tumor called an acoustic neuroma (a.k.a. a vestibular schwannoma).
Such tumors aren’t cancerous. They grow slowly – a couple of millimeters a year. But Webber’s had been doing so for years and was now about an inch-and-a-half (4 cm) across. When acoustic neuromas get that big, they become dangerous.
Usually too, Ridder says, acoustic neuromas happen in patients much older than Webber.
“I have an old soul, though – that’s probably why,” Webber joked.
But this was no laughing matter.
Webber’s tumor pressed into the brainstem, which regulates the most basic bodily functions: breathing, swallowing, sleeping, moving. As the tumor continued to grow, it could leave him wheelchair-bound or worse. Webber himself, seemingly calm to his core, was nonplussed. There would be surgery and he would be fine.
The news was tougher on his wife.
“I was in complete shock, to be honest,” Ramirez said. “We had just had our baby girl. We had just purchased our first home.”
Based on the MRI scans, Ridder expected the surgery at UCHealth Memorial Hospital Central to last about eight hours. By about 9 a.m. on Monday, April 22, Webber was anesthetized and lying on his right side so Ridder could access and remove the tumor though a roughly four-inch, arching incision over and behind his patient’s left ear.
Ridder peered into Webber’s skull through a bifocal microscope; he worked to peel and carve out the tumor with surgical instruments including an ultrasonic aspirator (which liquefies and then sucks out tissue), a cauterizer, and microscissors. By midafternoon, Ridder recognized that this tumor was going to take much longer than a standard workday to remove. It had grown into the brainstem as well as into the inner ear canal. UCHealth neurosurgeon M. Sean McKisic was soon in the operating room to join in what would become a marathon relay of a surgery.
Pass the baton
Roughly every two hours, Ridder and McKisic passed the notional baton. Both had done extended surgeries before. This one, though, combined meticulous, painstaking surgical work – Ridder described it as “removing intricate spiderwebs off a very delicate structure” – with the physical challenge of looking through a microscope with arms extended, which was tough on the shoulders.
They had to be precise in their spiderweb removal. Inadvertent damage to the brainstem during this sort of surgery can do to patients what the tumor would do over time: put them wheelchairs, render them unable to swallow (and thus needing a feeding tube), and, a particular risk in Webber’s case, do damage to the facial nerve, leaving half the face expressionless. The last of these, using electrical stimulation, Ridder could test during the surgery by electrically stimulating the nerve and observing whether facial muscles reacted – which in Webber’s case the muscles continued to do.
Things went smoothly if slowly until about 17 hours into the surgery, when a ventilator the anesthesiologist assumed would have been done with its job hours earlier stopped due to condensation in the line. A switch to a portable version bridged to a replacement, but all that took about an hour.
Ridder drank water (too much caffeine, he says, can affect his hands’ steadiness) and stayed focused during McKisic’s shifts, not even catnapping. You learn to deal with sleep deprivation during training as a neurosurgeon, he explained. Plus Webber and his family provided ample motivation to keep focus.
Ridder has two children just a little bit older than Webber’s. He has seen such surgeries “go the other way,” as he put it, where the brain stem takes a hit and the patient is never the same again.
“I was thinking about his kids the whole time,” Ridder said.
McKisic and Ridder kept going as the sun climbed into Tuesday. The 24-hour mark came and went. When it came time to remove a stretch of tumor that had grown into Webber’s left inner-ear canal, Ridder called in ear, nose and throat specialist Dr. Cameron Shaw, who used a tiny drill to demarcate the canal’s bone from the tumor crowding it. At 2:30 p.m. – 30 hours after Ridder made the first incision – he and McKisic were finally done. What does it feel like to wrap up a workday that lasts the better part of a standard workweek? Ridder put it this way:
“Like a lot of things in life, there are a lot of variables that we can’t control,” he said. “The way I look at it is, we’re lucky to be able to do what we do and help people, so I do what I can to do my best.”
Nine days later, Webber was home with his wife and kids. Aiden was careful not to wrestle with Dad as he otherwise would have loved to. Webber was soon helping out around the house and was back in the gym two months after surgery. By early August, his hair masked the scar from surgery. Clothing covered scars that had healed over bedsores on his right flank, the result of the extended surgery during which he had to remain firmly in place. As Webber had been told would be the case, the drilling in his left ear canal cost him his hearing in that ear. The only obvious remnant of the surgery was facial paralysis on the left side, which Ridder was surprised about – and, despite the high odds of it happening given the tumor’s size – disappointed with. Webber says his face is getting a bit better every day. If the paralysis doesn’t resolve within a year, a surgical procedure may be able to correct it, Ridder says.
One challenge Webber now faces is that working as a corrections officer is too risky, given the occasional physical nature of the work and the chance of taking a blow to the head. Webber is hoping to land a desk job at Spring Creek. Aiden, though, has been given the green light to wrestle with his dad, which the boy exploits.
Webber’s three-month MRI looked good, Ridder says: the surgeons managed to remove all but about 5% of the tumor, and if it starts to grow, they’ll be able to beat it back with targeted, noninvasive approaches such as CyberKnife, a type of stereotactic radiosurgery.
“I don’t think he’ll need surgery again,” Ridder said.
Webber’s father Jim, who was at UCHealth Memorial Hospital during the long surgery, called Ridder’s, McKisic’s and the rest of the Memorial team’s effort “incredible work that saved Chaise’s life.”
Maria Ramirez said her husband is his old self again, and she’s grateful to have him that way.
“Dr. Ridder was amazing,” she said.