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Náture Kastroulis: Right Trigeminal Schwannoma

She has medium length blonde hair. She wears bright lipstick. She wears a black blouse.

The Challenge: Right Trigeminal Schwannoma

Náture Kastroulis is a stay-at-home mom from Jacksonville Beach, Florida, and no stranger to homeschooling her two young children. Her family traditionally spends part of each year in Greece, where most of her husband’s family lives.

In 2020, Náture continued homeschooling in response to the Covid-19 pandemic. Though she and her family couldn’t travel to Greece as usual, Náture handled the unprecedented and uncertain circumstances created by the pandemic with grace and poise.

"I'll never forget the moment after surgery when I felt my son kiss me on the cheek." — Náture

It’s not the first time Náture’s positive outlook on life has served her in times of personal stress and uncertainty. In September 2015, she went on a cruise with her family and woke up one morning with the right side of her face completely numb.

“I thought, since I was on a ship, that I might have pinched a nerve in my neck from sleeping on different pillows,” she recalls. “But then every day, my face kept getting more and more numb.”

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A week later, when the cruise finished, Náture felt like she was suffering from a really bad sinus infection. She went to a doctor, who treated her for one. However, the problem didn’t go away. Her symptoms escalated to an extreme pain in her head and vomiting, which resulted in many trips to the emergency room.

Náture underwent an MRI.

“Right after the MRI, the radiologist came in and said in 20 years, he hadn’t seen anything like it,” she says.

The radiologist identified the source of Náture’s symptoms – a rare neurological occurrence called a right trigeminal schwannoma.

The Path to UPMC

A schwannoma is a tumor in the nervous system. The nerves are insulated by a protective sheath called myelin, which transmits nerve impulses throughout the body.

When a schwannoma tumor develops, it forms around the tissue of the myelin sheath and can compress the nerves, causing symptoms such as tingling, weakness, and numbness. If left untreated, it could cause significant nerve and spinal damage.

Náture knew she had to find a neurosurgeon, but because her schwannoma was positioned on a nerve behind her right eye, all the local neurosurgeons she contacted would not perform the surgery necessary to remove it, for fear it would be too risky.

While researching neurosurgeons outside of Florida who might be willing to take on her complex case, Náture discovered UPMC’s Department of Neurosurgery, known for pioneering cutting-edge techniques to treat conditions like her schwannoma. She sent in her medical history.

A few days later, she received a call from Paul A. Gardner, MD, director of the Center for Skull Base Surgery at UPMC. Dr. Gardner offered to perform the surgery that, up to this point, seemed elusive.

Náture appreciated that Dr. Gardner called her personally. She also felt reassured when he told her that, after the surgery, he wanted her to stay in Pittsburgh for two weeks to ensure a proper recovery.

“That was the dealmaker for me,” she says. “That’s when I knew he was going to be my surgeon.”

The Solution: Right Lateral Orbitotomy

On June 6, 2016, Náture and her husband flew to Pittsburgh for Náture’s surgery scheduled on June 8. Her children stayed behind in Florida with their grandmother, who would take care of them as Náture recovered.

“The prospect of surgery was nerve-wracking,” she says. “But I knew this is what I had to do and I could deal with it. I tried to look at it this way – I’m a mom with little children. I haven’t had a good nap in a really long time. The surgery would be a good night’s sleep, at least.”

Dr. Gardner and Georgios Zenonos, MD, associate director of the UPMC Center for Cranial Base Surgery, along with S. Tonya Stefko, MD, FACS, director of the UPMC Orbital, Ocuplastic, and Aesthetic Surgery Service, performed a right lateral orbitotomy to remove Náture’s schwannoma. During this minimally invasive procedure, Dr. Gardner gained access to the schwannoma through a very small incision in the crease next to Náture’s right eye. Using a microscope, endoscope, and intraoperative electrophysiological monitoring, he opened the nerve sheath and carefully removed the schwannoma.

Eight hours later, Náture woke up schwannoma-free. She spent four days recovering in the hospital before transitioning to a rented apartment for the duration of her time in Pittsburgh.

The Results

Náture experienced some soreness from surgery, but was able to sightsee around Pittsburgh a week after, which she considered a success. The post-surgical swelling in her right eye eventually went down, and she returned home to Florida, delighted to see her kids.

Náture occasionally experiences headaches and has to carefully monitor her right eye, which is prone to drying out as a result of the nerve involved with the tumor. She also has a collagen filler injected every year near her right eye to help her face keep its natural shape. Despite these setbacks, she has been able to return to an active lifestyle with her family.

“I was pretty blessed,” Náture says. “I’ll never forget the moment after surgery when I felt my son kiss me on the cheek, something I couldn’t have felt before. I cried; I was so overwhelmed with happiness.”

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.

Náture’s treatment and results may not be representative of all similar cases.

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