Grueling Op Gives Her Hope

Daily News

Brain Surgery Can't Dampen Patient's Sense Of Humor

Minutes before she was to undergo lifesaving surgery, Rebecca Sweat kept her sense of humor.

“Tell them I'm here for a boob job,” joked the 35-year-old social worker from Florida.

If only it were that simple.

Sweat recently learned that a severe blood vessel disorder had caused part of her brain to sink through a hole in her skull into her nasal cavity, endangering her life.

She would need her sense of humor to get her through a grueling, five-hour operation Monday, where neurosurgeons at St. Luke's-Roosevelt Hospital's center for Cranial Base Surgery amputated part of her brain.

Sweat, whose congenital disorder has disfigured her face and turned it the color of a deep bruise, has one of the most severe cases of blood vessel damage surgeons there have seen, said her primary surgeon, Dr. Peter Costantino.

Sweat, of lake Butler,Fla., is now recovering from the unique surgery, which was observed by the Daily News.

Sweat's disorder eroded the bone separating her brain from her nasal cavity, creating a hole called an encephalocele. Doctors said she was at risk of catching a cold that could go to her brain, or spinal fluid could cause meningitis – both fatal situations.

“It took us a few days to get over the shock and to grieve, but then I thought, I can't lose my wife,” said her devoted husband, Randall Mobley, 34.

Costantino, a craniofacial surgeon, began with an ear-to-ear incision on top of Sweat's head and slowly folded her scalp and forehead skin over her eyes to expose her skull. Then doctors sawed through the top of her skull to lift out a triangular portion of the skull and enter the nasal passage.

With access to Sweat's  brain and nasal passage, neurosurgeon Dr. Chandranath Sen began to delicately remove the nonfunctioning part of her brain that had herniated and fallen down between her eye sockets. She has lost her sense of smell from the brain hernia.

Sen performs about 150 encephalocele repair surgeries each year, but Sweat's extreme vascular disorder – in which her blood vessels swell and bleed spontaneously – made this surgery particularly complicated. Doctors had hoped to rebuild Sweat's collapsed left eye socket during the surgery, but the vascular damage made that too dangerous.

They built a barrier of titanium mesh and fatty tissue from her abdomen between her brain and her nasal cavity, then reinforced the membrane sack around the brain with a patching material that becomes living tissue.

Finally, surgeons reconstructed her skull with titanium mesh, screws, her own bone and glue, before stitching her scalp back together.

Mobley has asked that no one tell his wife that doctors could not repair her eye.

“She'll be disappointed, but the biggest thing is that she'll no longer have to fear for her life,” he said.

Sweat has had more than 70 treatments and surgeries and faces additional operations in the summer to rebuild her lower face. Family and friends say she has coped graciously with spontaneous hemorrhages, cruel stares and comments –even children looking at her and screaming.

She was sedated last night, but still in pain, with two drainage tubes in her head and a breathing tube attached.

“She is able to appreciate a little humor,” Mobley said.

“She's the strongest person I've ever known”.