In a news conference Thursday at University of Miami Hospital, where the surgery was performed in November, the surgeon, Ricardo Komotar, M.D., assistant professor of neurological surgery at the Miller School of Medicine and Co-Director of Surgical Neuro-oncology at Sylvester, and the patient, Palm Beach County Sheriff’s Deputy Shawn Monti, discussed the procedure. Komotar and Monti, who had been awake during the surgery, spoke as a video that showed removal of the fluorescent tumor played in the background.
Over a year ago, Monti, 46, went to the doctor, thinking he was having a sinus headache. When antibiotics didn’t work and he started acting strangely, his wife took him to the emergency room, where a scan revealed something far worse. The father of five had a glioblastoma — an aggressive brain tumor that makes up 80 percent of all malignant brain tumors.
“I’m told I was saying things that didn’t make sense and doing odd things like putting items away in the refrigerator that belonged in the cupboard,” said Monti, who was accompanied by his wife, Kathy, and his youngest child, Faith, who is 13. “I don’t remember doing these things, but my family was extremely concerned.”
Monti was initially given six months to live, but then he was referred to Komotar, and things began to turn around emotionally for the family.
“It was really hard when we heard the news,” said Faith. “We were all very scared, but Dr. Komotar gave us hope.”
“I told Shawn we would attack his cancer with everything we had,” said Komotar, who added that being in the forefront of surgical technology “is what patients should expect from an academic medical center.”
The first surgery was a success, but in November Monti’s cancer recurred in a different spot, right next to the motor strip that controls the body’s movements. The new location presented a more serious challenge with much greater risks.
For the second surgery, Komotar performed an awake craniotomy and injected Monti with sodium fluorescein, a fluorescent tracer that illuminates the tumor tissue, making it glow and appear distinct from healthy tissue. Then, while viewing the tumor through a special filter, the surgeon carefully removed it. He was assisted by advanced neuro-navigation technology, and his team spoke with Monti throughout the procedure, instructing him to move various parts of his body in order to make sure his mobility was not being affected.
“The role of the surgeon is to prolong and maintain quality of life,” said Komotar. “Shawn had a large tumor, and my goal was to remove as much of the tumor as safely possible. We know that’s our best shot at extending longevity and preserving quality of life. Using biofluorescence maximizes our ability to safely remove the tumor while preserving healthy tissue.”
As the video played, Komotar traced the outlines of the tumor, explaining how its blood vessels leak the sodium fluorescein, causing the tumor to glow, whereas the blood vessels in healthy brain tissue do not leak the drug.
But, he cautioned, surgery alone is not a cure for this type of cancer.
“Shawn will still need to undergo chemotherapy, and he will be participating in a clinical trial, so we will be following his progress over the next several months,” he said. “Still, considering his extent of resection, he’s starting from a good place.”
“This is what we work for every day — to improve outcomes and the quality of life,” added Sylvester Director Stephen D. Nimer, M.D., professor of medicine, biochemistry and molecular biology. “A procedure like Mr. Monti’s requires someone of Dr. Komotar’s skill so you don’t take too much. Getting that balance right is what the real experts here at Sylvester know how to do.”
Komotar, who has led a brain cancer vaccine clinical trial and was the first surgeon in the southeastern U.S. to use laser ablation on brain tumors, describes the use of biofluorescence as “a potential game changer. It can help us improve the quality of life for these patients. It will hopefully become standard of care for difficult cases like Shawn’s.”
Monti, meanwhile, is back at work, although performing office duties. His goal is to eventually return to full active duty.
“We put all of our trust in Dr. Komotar,” said Kathy Monti, 49, who has known her husband since high school. “I thank the University of Miami and Dr. Komotar and the Lord every day for giving Shawn another chance at life. Somehow my husband has kept his sense of humor throughout this whole experience.”
Monti proved her point a few moments later when he said, “At least the video shows I have a brain.” Looking at his wife, he added, “That has sometimes been questioned in the past.”
A study in the Journal of Neurosurgery last February reported the success of using fluorescence to illuminate brain tumor cells. Researchers found that fluorescence was more effective than MRI and surgical microscopes in revealing tumor tissue that is difficult to identify.
Another publication in October in Neurosurgical Review concluded that fluorescein-guided surgery is safe, effective and a convenient way to increase total removal of malignant glioblastomas.
Physicians and scientists are eagerly investigating new therapies that can enhance the current options of surgery, chemotherapy and radiation. Nearly 70,000 new cases of primary brain tumors will be diagnosed this year, and in that same span nearly 14,000 patients will lose their battle with a brain tumor.
University of Miami