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Edith Smith: Odontoid Synovial Cyst

She has shoulder length gray hair. She is smiling brightly. She wears gold hoop earrings and silver glasses.

The Challenge

It's common to hear people say, "Listen to your body," and as Edith Smith learned, it's a good rule to stand by. This vibrant, 71–year-old, on-the-go registered nurse didn't listen and may not have had her symptoms checked out had it not been for the urging of a co-worker. Edith's action may have saved her life.

"I was relaxed and calm. I knew this had to be done and that I was in good hands." — Edith

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The Path to UPMC

It was recurrent dizziness, headaches, and weakness in her legs that led Edith to the Emergency Department. While there, an MRI revealed a lesion at the base of her brain.

The lesion was an odontoid synovial cyst associated with an unstable joint between the top two vertebrae (C1 and C2). The lesion was pressing against her brain stem, pushing it out of position and causing her spinal cord to curve. Surgeons were leery of performing surgery, fearing Edith might be left quadriplegic. However, something needed to be done about the lesion. Edith was told that a fall, a bump, or simply rolling over in bed the wrong way could cause severe damage, even paralysis.

She was referred to UPMC, where surgeons told her that the lesion could be removed through her nose, using the endoscopic endonasal approach. She would also need to have her cervical spine fused for stability once the lesion was removed.

The Solution

The two-part surgery took a total of nine hours. The synovial cyst was removed through Edith's nose, immediately relieving the pressure from the brain stem.

With the pressure relieved, her spinal cord straightened. Then, the top two vertebrae were fused together to treat the instability that led to the cyst formation. Her spine was stabilized with two rods and four screws in the top two vertebrae. After surgery, Edith wore a cervical collar for eight weeks while the fusion healed. Edith says she is thankful for the EEA procedure and glad the doctors didn't have to use the traditional approach of opening her skull or cutting through the back of her throat to remove the lesion. After surgery, she had no pain except for some discomfort in the back of her neck that was relieved with mild pain relievers.

The Results

Three months after surgery, MRIs reveal that Edith's spine has straightened. The fusions were successful and she is starting to grow new bone. She says that having confidence in your doctors, and following their orders, helps the healing process.

"I was relaxed and calm. I knew this had to be done and that I was in good hands," says Edith. Her advice to others is, "Don't get worked up about things that you cannot control. Try to be healthy and calm and you'll recover better."

Our patient stories profile a number of patients who have had minimally invasive brain surgery at UPMC. Although everyone's care experience is unique, we hope that sharing these stories will help other prospective patients and their families better understand these procedures and their potential benefits.

Edith's treatment and results may not be representative of all similar cases.

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