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Brain Storm

Ten-Hour Brain Surgery Successfully Restores a La Quinta Man’s Life

It felt like every time I took a step, someone was putting a knife in my head. And even though I was still running and working out, my motor skills were starting to be impacted.
It felt like every time I took a step, someone was putting a knife in my head. And even though I was still running and working out, my motor skills were starting to be impacted." - Andy Alvillar
Andy Alvillar, 43, knew he had a brain tumor for more than a decade.

“I was in my early thirties, living in Los Angeles and just wasn’t feeling right,” he recalls. After seeing several doctors who gave him a clean bill of health, he finally saw a neurologist who agreed to order a brain magnetic resonance imaging (MRI).

“He found a small [non-malignant] tumor in a delicate part of my brain and referred me to a neurosurgeon,” Alvillar says. “She felt surgery was too risky, so the neurologist sent me to another neurosurgeon at UCLA. He didn’t think the tumor was causing symptoms, but if it needed to be taken out some day, he felt he could do the procedure.”

“At the time, I didn’t want to have anyone cut into my head,” Alvillar says. He agreed to annual checkups and “watchful waiting.” After a few years, imaging revealed that the tumor had grown, but it wasn’t impacting Alvillar from a neurological standpoint.

By 2007, Alvillar had been working for a real estate developer in the Las Vegas area for several years. When the economy soured, he decided to go out on his own and eventually ended up managing a project in Baton Rouge, Louisiana. His wife and three children remained in Nevada, so Alvillar traveled back and forth until 2012 when his family finally joined him in Louisiana.

During this time, however, Alvillar began experiencing some troubling symptoms.

After surgery in May, “today I’m back to running 20 miles a week, doing nine-minute miles,” says Alvillar. [1445]
After surgery in May, “today I’m back to running 20 miles a week, doing nine-minute miles,” says Alvillar.
“I’d go for a walk with the kids and look up at the trees and everything would start spinning,” he recalls. “I’m fairly active, running three to five miles a day and lifting weights, but bending down would make me dizzy. I experienced the same thing if I spun my head around while playing catch with the boys. My neck also started to hurt.”

“I knew I had this thing in my head, but doctors had told me for so long that it wasn’t doing anything,” Alvillar explains. “So, I went to see a dentist and an ear, nose and throat specialist. They did tests and I was doing all this stuff, spending thousands, but I wasn’t getting any better.”

Meanwhile, Alvillar’s wife wasn’t happy living in the South — having moved to Baton Rouge just a couple of weeks before Hurricane Isaac hit the Gulf coast didn’t endear her to the area. Like Alvillar, she’d been raised in the desert southwest, and she wanted to return to that part of the country.

Alvillar began reaching out to his contacts and, through a providential connection, he landed a job in the Coachella Valley. He and his family moved to La Quinta in March 2013.

By this time, Alvillar’s symptoms were even worse.

“I was not only having vertigo but also nausea, vomiting and pain,” he relates. “I was sleeping sitting up because lying down made everything worse. It felt like every time I took a step, someone was putting a knife in my head. And even though I was still running and working out, my motor skills were starting to be impacted.”

Within days of moving to the desert, Alvillar went to see an internist in Los Angeles who told him to see a neurologist as soon as he got home. He went online and found Eisenhower Neurologist Bishoy Labib, MD, and scheduled an appointment.

After Dr. Labib reviewed Alvillar’s brain imaging, he told Alvillar that his tumor, called a hemangioblastoma, had grown dramatically and was pressing on his brain stem. This was obstructing the normal flow of cerebrospinal fluid through the brain, a condition called obstructive hydrocephalus. It was also increasing the pressure inside Alvillar’s skull causing intracranial hypertension. Plus, because hemangioblastomas are vascular (blood vessel-fed) tumors surrounded by cystic fluid, there was a risk of hemorrhage, which could be life-threatening.

“Dr. Labib told me that I was going to need surgery,” Alvillar says. “When I asked him if I should call the UCLA neurosurgeon, he said, ‘No, you need to see a gentleman here in the desert, and I’ll call him right now.’”

“The margin for error is one millimeter or less, so the risk of
complications is significant.” — Farhad Limonadi, MD [4038]
“The margin for error is one millimeter or less, so the risk of complications is significant.” — Farhad Limonadi, MD
That gentleman was Eisenhower Neurosurgeon Farhad Limonadi, MD, and he agreed to see Alvillar the next week. “At this point, watching and waiting was not a good option anymore,” Dr. Limonadi says. “The best option, as difficult as it would be, was to surgically remove the tumor.”

Dr. Limonadi explains that when a hemangioblastoma is adjacent to the brain stem, removing it is particularly complicated and dangerous.

“The margin for error is one millimeter or less, so the risk of complications is significant,” he says. “I had a frank discussion of these risks with Mr. Alvillar to ensure that he had realistic expectations.”

Dr. Limonadi proceeded with the surgery on May 8, 2013, using state-of-the-art intraoperative neurophysiologic monitoring and computer navigation for optimal precision. It was a ten-hour procedure.

“The procedure went excellently,” Dr. Limonadi says. “The tumor was nicely circumscribed and removed, and the postoperative MRI showed no residual tumor. Most importantly, ventriculoperitoneal shunt placement — which would have necessitated surgically implanting a permanent tube to drain fluid from the brain into the abdominal cavity — was no longer necessary, as by removing the tumor, the cause of hydrocephalus was appropriately dealt with.” “Mr. Alvillar has returned to completely normal neurological status and most of his symptoms have resolved,” he adds. “He is tumor-free and will remain so.”

Alvillar spent five days in Eisenhower’s intensive care unit after his surgery and was discharged ten days postoperatively.

“Thirty days later I was back at work,” he says. “And today I’m back to running 20 miles a week, doing nine-minute miles.”

“I believe it is divine intervention that I’m sitting in the Coachella Valley as a beneficiary of God’s grace so I could be a patient of Dr. Limonadi,” Alvillar adds. “Considering all the risks involved in my surgery, Dr. Limonadi is amazing, and his team is amazing. I think the world of him — I ended up where I was supposed to be.”

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