Mira Cymerman: The Gift of an Unusual Sign
Mira Cymerman's left ear was sending her a message. After seeing doctors for persistent ear pain in the fall of 2019, she left with ear drops, an antibiotic, and steroids to reduce the inflammation. "We thought it was just an ear infection," recalls Mira, a school psychologist and special education committee chair for White Plains, New York schools. "But it turned out to be so much more."
The treatment reduced the inflammation, but she still felt like the hearing in her left ear wasn't as good as in her right ear. One of her doctors, an Ear, Nose and Throat (ENT) physician, sent her for an MRI that revealed something surprising: a meningioma tumor on the right side of her brain stem in the posterior fossa. These tumors arise from the meninges, the membranes around the brain and spinal cord, and they are typically benign (noncancerous). But with the brain stem responsible for such vital functions as breathing and heart rate, there was extra cause for concern. The tumor was also compressing all of her cranial nerves, which regulate numerous functions such as vocal cord movement, tongue movement, and facial expressions, among others.
Ms. Cymerman consulted with several neurosurgeons. One said it was nothing to be concerned about. Another said out should probably come out at some point. On the advice of her ENT, she saw Joshua B. Bederson, MD, the Leonard I. Malis, MD/Corinne and Joseph Graber Professor of Neurosurgery and Chair of the Department of Neurosurgery for the Mount Sinai Health System. "He said it should definitely come out and that I might even need two operations," recalls Ms. Cymerman, who lives in Chappaqua, New York with her husband, Barry. "I was upset and I cried. But when I learned it was probably benign, I felt lucky it was found." She says Dr. Bederson and Leslie Schlachter, PA-C, Chief Physician Assistant and Clinical Director in the Department of Neurosurgery, reassured her. "They were always available to me and quickly responded to my questions and emails," she says.
She learned that the second surgery would be a possibility if the tumor turned out to be very dense, and that Dr. Bederson wouldn't be able to determine that until the first surgery had begun. Ms. Cymerman got to see information about the tumor's location using the department's Virtual Reality (VR) Brain Tumor Simulator. Wearing special VR goggles and guided by Ms. Schlachter, Ms. Cymerman watched a digital "fly-through" of her brain and could see how big the tumor was (4 to 5 cm) and where it was sitting. "I'm the kind of person who wants to know everything, and seeing it with virtual reality made it all very real," she explains.
Moreover, the VR data gave Dr. Bederson and his team the GPS coordinates they needed to navigate through Ms. Cymerman's brain. Using augmented reality tools not available in many centers, he and his team were able to practice the surgery virtually, using special eyepieces to direct him through the blood vessels of the brain and better understand the challenges they would face during the actual procedure. Working with exceptional precision as he carefully divided the tumor from normal tissue, he removed the grade 1 meningioma during an 8-hour surgery on December 12, 2019.
Ms. Cymerman doesn't really remember much of the first couple of days. When she came out of anesthesia, she was rapping "y'all gonna make me lose my mind!" — lyrics from the DMX song "Party Up." As she recovered, she had some double vision and ear popping — "like on an airplane," she says — but she otherwise feels fine.
It turns out that her tumor did turn out to be dense, though an MRI performed in May 2020 showed no significant growth of the remaining bits of tumor. She continues to recover and regain her energy, and her vision and hearing are now fine.
As she recovers, Ms. Cymerman is enjoying the simple pleasures in her life: walking on a treadmill, strolling with Barry and her dachshund, Brando, and taking care of routine tasks around her home. "This experience forced me to take better care of myself," she says. "I have Dr. Bederson, Leslie, and the rest of my team to thank for my life. Their positive spirit has made a difficult experience much better."