Are you okay?” the fourth-grader asked his math teacher. Lauren Barbosa, 39, wasn’t so sure. She was about to start a remote class one day in November, 2020, when she instantly lost her ability to speak.
“I knew what I wanted to say and my lips were moving, but I just couldn’t get anything out,” Barbosa recalls. “And I’m never at a loss for words.” Not wanting to alarm her students, she ended the session and ran to the bathroom mirror. A couple of minutes later, she was finally able to say the words she had been struggling to utter: “I can multiply and divide whole numbers.”
Despite having no other symptoms, Barbosa feared a stroke. Her husband, Leonardo, brought her to the Emergency Department at NYU Langone Hospital—Long Island, a short drive from where they were then living in Westbury, New York. “It’s a great hospital and I knew they would take good care of me,” she says. “It’s where I was born, where my son, Dylan, was born, and where my husband once worked as a patient transport attendant.”
Brain scans ruled out a stroke, but revealed a suspicious lesion. Several days later, Barbosa met with Lee Tessler, MD, chief of neurosurgery at NYU Langone Hospital—Long Island. The hospital’s neurosurgery program, part of Perlmutter Cancer Center, is ranked number one on Long Island by U.S. News & World Report, and its doctors perform over 1,200 related procedures each year.
“Dr. Tessler made me feel comfortable right away,” says Barbosa. “He said, ‘Don’t worry, whatever this is, we’re going to take care of it.’” Dr. Tessler told Barbosa that the episode was most likely caused by a seizure, so he prescribed an anti-seizure medication and asked her not to drive. He also ordered a lumbar puncture to check her cerebrospinal fluid for signs of infection and additional scans to rule out metastasis from another part of her body.
“By seeing the areas that control speech preoperatively, I was able to find a natural fold in the tissue that led almost directly to the tumor. During surgery, I would incorporate that data into our 3-D navigation system so that I could operate without causing permanent injury.”
—Dr. Lee Tessler, Neurosurgeon at Perlmutter Cancer Center
When all the test results came back negative, Dr. Tessler narrowed down the potential diagnosis to a primary brain tumor. He suspected an astrocytoma, named for the star-shaped cells where such tumors originate—cells that “clean out debris in the brain,” as Dr. Tessler puts it.
The most common type of brain tumor in adults, astrocytomas affect some 15,000 Americans each year. Unlike discrete solid tumors, they infiltrate healthy brain tissue as cancerous cells spread in between normal cells. Barbosa’s tumor was located in the left parietal lobe, which controls language and speech.
“This is one of the more challenging parts of the brain to operate on,” notes Dr. Tessler. There are two important eloquent areas of the brain related to speech. One allows you to speak and another allows you to understand speech. They’re connected by a fiber tract, and that’s where Barbosa’s tumor was situated.
“Damage to this part of the brain is a very devastating injury,” says Dr. Tessler. “The person could speak, but their words wouldn’t make any sense because they wouldn’t know what they were saying, even though they would think they knew what they were saying.”
Barbosa’s tumor was about the width of a dime—big enough to trigger a seizure. “While we caught the tumor early due to Lauren’s episode of speechlessness,” says Dr. Tessler, “it was in a deeper part of the brain that’s more difficult to access without damaging tissue.”
To frame his battle plan, Dr. Tessler used an imaging technology called magnetic resonance (MR) tractography, which enables the surgeon to visualize functional areas of the brain and their corresponding fiber tracts. “By seeing the areas that control speech preoperatively, I was able to find a natural fold in the tissue that led almost directly to the tumor,” Dr. Tessler explains. “During surgery, I would incorporate that data into our 3-D navigation system so that I could operate without causing permanent injury.”
Dr. Tessler explained to Barbosa that he would need to perform a procedure known as an awake craniotomy, which was scheduled for December 21. “He said, ‘We’re going to do this while you’re awake,’” she recalls. “I looked at him and said, ‘Are you kidding?’”
With speech, he explained to Barbosa, the only way to test brain function is with the patient awake. “If I probe an area and you stop speaking, or stop being able to name things or identify pictures, I avoid that area,” Dr. Tessler told her. “I use this feedback to fine-tune how to get to the tumor and what to remove.” Dr. Tessler reassured Barbosa that the brain itself doesn’t feel pain, and nerve blocks are used to numb the scalp.
Just before Barbosa was sedated, Dr. Tessler informed her that it was the birthday of the neuropsychologist who would be asking her questions during the procedure. “When you become alert,” Dr. Tessler said to her, “It would be great if you would wish him a happy birthday.” Barbosa did one better. She launched into the “Happy Birthday” song, drawing laughter from the operating room team. “We want the patient relaxed,” explains Dr. Tessler. “But it was incredible that Lauren could do that.” On the morning of December 23, Dr. Tessler gave Barbosa two pieces of good news: the surgery went well and she would be home before Christmas Eve.
After surgery, it took several months for her speech to return to normal, but today, with no permanent deficits, Barbosa is back at school, teaching on a full schedule. At a recent follow-up visit, she asked Dr. Tessler if she could ride a roller coaster or go zip lining. “Your scans look amazing,” he replied. “Go for it.” Barbosa has no plans for either activity. “I just wanted to make sure that I could do anything again,” she says. “And I definitely can.”