Awake Brain Tumor Surgery Gives Valeria Back Her Quality of Life

Valeria Diggs is used to having a sharp memory. In her career as a human resources specialist for the federal government, Valeria is known as the go-to person for HR-related questions and time-sensitive requests. But in September 2019, the job she was so good at suddenly became harder to do.

“I couldn’t remember things as well at work. It was harder for me to answer questions that were coming in via email, and I was also having headaches. I was concerned,” Valeria said.

Valeria went to her primary care doctor to start a workup, but by mid-October, she was struggling to remember the names of her beloved grandchildren – Jaleel, Nailah and Khalil. On October 22, her forgetfulness and confusion had become so severe that she left work and headed to the emergency room at Inova Mount Vernon Hospital. A CT scan revealed a mass in her brain, and she was transferred by ambulance to Inova Fairfax Hospital that evening.

Valeria met with Inova Neurosciences’ team of neurosurgery experts right away, and three days later her tumor was successfully removed by a Inova Neurosciences neurosurgeon. A few days later the pathology results came back, revealing a devastating diagnosis: the tumor was a glioblastoma, a fast-growing form of brain cancer with a high chance of coming back. From that point forward, Valeria’s care was coordinated between Inova Neurosciences and Inova Schar Cancer Institute, including chemotherapy and proton therapy treatment as well as ongoing monitoring.

In February 2021, Valeria once again began to notice forgetfulness and confusion. An MRI in March confirmed her fears: the tumor had returned. Valeria met with Inova neurosurgeon and fellowship-trained brain tumor specialist Mateo Ziu, MD, Program Director, Brain and Spine Tumor, Inova Neurosciences and Co-Director, Neuro-Oncology, Inova Schar Cancer Institute.

Valeria’s symptoms were increasing, and there was no time to waste. “We got a call from Dr. Ziu’s office asking if we could come in that same day. They were just amazing. Dr. Ziu showed us all of the MRIs so that we could see the changes that had been taking place,” Valeria’s daughter, Kizzy Diggs, remembered. “Everyone on his team was excellent: very calming, presenting us with options and explaining what to expect. Even though it was a whirlwind, with a lot of scary information coming at us, we trusted Dr. Ziu.”

“This time, the tumor had spread over an extended region, including the left temporal lobe around the area that controls the speech function. It was causing her word-finding difficulties, alteration of speech, and memory, as well as headaches and confusion,” Dr. Ziu said.

Shortly after the appointment with Dr. Ziu, Valeria’s condition began to decline rapidly. She was admitted to Inova Fairfax Hospital in late March to prepare for a second brain surgery. “Because of the tumor’s location, I decided to perform the surgery with her awake so that we could test her speech during the surgery and avoid any further damage to that vital function.” Dr. Ziu said.

This complex procedure begins in the pre-operative area, where a neurophysiologist shows the patient cards with numbers and pictures such as an apple or a star. The patient’s answers form a baseline that the team can use during surgery. Once the patient is in the operating room under anesthesia, Dr. Ziu uses several leading-edge neuromapping technologies to identify the exact area of the brain that controls speech and memory. A computerized navigation system that shows the nerve tracts helps Dr. Ziu plan where to make the incision into the brain, and neurophysiology monitoring uses electrodes to map signals from the brain’s nerves.

“Unlike a liver or a spleen, the brain looks uniform – there is no way to tell just by looking where, for example, the speech center is located. Moreover, brain tumors cause areas of the brain to shift, and a brain that has been operated on and that has undergone radiation, as Valeria’s had, has even more differences. For these reasons, it’s essential to use testing and mapping technology to pinpoint the area,” Dr. Ziu said.

Next, after the incision has been made and the brain has been exposed while patient is under anesthesia, Dr. Ziu’s team wakes the patient up so that the neurophysiologist and anesthesiologist can start conversing with the patient and show the patient the same set of cards that they did before surgery while Dr. Ziu stimulates the brain with a probe until the patient’s speech changes or stops. This is how the speech areas are identified. “After that process is complete, I start the surgery to remove the tumor, avoiding the areas that control speech,” he said.

On April 1, Dr. Ziu used these techniques to remove as much of Valeria’s tumor as possible, without taking away her ability to speak. Inova’s strengths in brain tumor care, including fellowship-trained brain tumor experts like Dr. Ziu, mean that patients like Valeria don’t need to go anywhere else to get world-class care. “At Inova, we have a multidisciplinary team that works together to develop a treatment plan. It’s not just one person making a recommendation. We also have all of the state-of-the-art technology that we need for the treatment of patients with these complex brain tumors, including navigation systems, advanced neurophysiological monitoring, laser interstitial ablation therapy, and minimally invasive surgical techniques,” Dr. Ziu said.

After surgery, Valeria in the hospital, followed by a week working with Inova’s neurorehabilitation experts in Inova Schar’s inpatient rehabilitation unit to recover her speech and memory skills. She continues to have visits from a speech therapist at home – and talking with friends and family who come to visit is also helpful. Scans conducted in mid-July 2021 continue to look promising, and the family is hopeful. Valeria is also back to work on a part-time, remote basis. The Diggs family will celebrate in August with a trip to Orlando, including lots of time at the beach as well as a visit to Disney World.

“Dr. Ziu, and everyone who works with him, is just wonderful,” Valeria said. “I was treated so well, and I am feeling good right now.”

“Her life is going to look a little different, and the challenge now is finding what her new normal is, but she has made so much progress compared to where she was.” Kizzy said. “We’re grateful to Dr. Ziu. He kept us so well informed and was incredibly patient and calming. I can’t say enough about his whole team’s responsiveness, professionalism, attention to detail, and communication.”

Learn more about the Inova Brain and Spine Tumor Program, where our experts treat benign and malignant brain, spine and pituitary tumors, or call 571-472-4100 for information.