Awake to Dance: Surgery for Brain Tumor Requires Awake Craniotomy
Chelsea Cusack became a ballerina. At 20 years old, she had all the qualifications: she had graduated from Denver School of the Arts, danced with Joffrey Ballet School in New York City and worked as a professional dancer at Ballet Ariel in Denver.
In the summer of 2010, in the midst of teaching ballet, preparing for the upcoming season and living as a fresh twenty-something, Chelsea's head started to hurt. A few headaches turned into daylong headaches every day. She became uncharacteristically depressed.
Her mother, Anni Cusack, went on alert immediately. Her older daughter had suffered from osteosarcoma, a form of cancer, 15 years earlier. She lived, thanks to Children's Hospital Colorado, but not without losing her leg after three relapses.
Anni thus took Chelsea to a local primary care physician. An MRI revealed a tumor in the left side of Chelsea's brain. She consulted a local hospital for treatment; according to Chelsea and her mom, the hospital did not share their level of concern, deeming it "not a big issue."
Anni felt uncertain about this laid-back attitude and wanted to check with Children's Colorado's neurology experts to be sure. Although Children's Colorado primarily serves those under 18 years of age, Dr. Handler agreed to meet with Chelsea. He showed far more concern for her condition. "I don't trust the edges of this [tumor]," Chelsea remembers him saying, and he soon scheduled her for brain surgery.
This first surgery provided two conclusions for Dr. Handler and his colleagues: they had to remove the tumor and they had to do it without general anesthesia.
This meant Chelsea would lie awake for part of her surgery in an operation known as an awake craniotomy. This type of surgery entailed mapping, a technique that tests functions of the brain during the operation, ensuring less damage to affected areas. Chelsea's tumor resided in areas of her brain that controlled language and motor skills. If Chelsea wanted to remain a dancer, mapping was imperative.
"But we knew we had to do it," Anni said. "Honestly, I was pretty confident. It wasn't hard to understand why they were doing this."
"They explained what could happen. I could lose my personality," Chelsea said. "But it definitely had to be done - we had no choice. Dr. Handler said it was the way to go. We trusted him, with good reason."
"I knew Dr. Handler was an outstanding doctor," Anni added.
In November 2010, Chelsea underwent an awake craniotomy.
"It was like a crazy, crazy dream," she said. "I remembered the surgery. I've never experienced anything like it. The night before, I shook in my bed, scared they would take my personality. I've worked so hard to become who I am."
Before surgery, Dr. Handler warned Chelsea and Anni that she might not talk afterward. During the surgery, however, a neuropsychologist and epileptologist tested Chelsea's language, assessing understanding and expression. They identified the brain areas required for language and motor skills so the surgeon could avoid them.
"I knew right away she'd be fine," Anni said. "She felt a lot better than we expected."
Chelsea's surgery had been a success, thanks to a skilled team in the operating room. There were anesthesiologists to manage her pain and sedation; there was an epileptologist who looked for seizure activity; there was the neuropsychologist who looked for functional changes. Thanks to the team, Chelsea could talk and move; she hadn't changed a bit. The neurology team at Children's Colorado told her she could expect to wait up to six weeks before dancing again, but she was on the floor in three.
"It's an incredible success story," Anni said. "It's really something to share so others can find comfort."
In spring 2011, Chelsea danced in Ballet Ariel's performance of Avoca.
"Chelsea continues to light up the stage," Anni added.