Third Grader's Class Project Pays Tribute to Neurosurgeon for Saving Mom's Life

He could have chosen any current or historical author for the March 15 assignment. But dressed in scrubs and wearing a blue surgical cap, beaming Jesse Waldman stood before his third-grade class with a homemade poster bearing pictures of his career role model.

He had chosen Keith L. Black, MD, professor and chairman of the Department of Neurosurgery at Cedars-Sinai, director of the Maxine Dunitz Neurosurgical Institute at the medical center, director of Cedar-Sinai’s Johnnie L. Cochran Jr. Brain Tumor Center and the institution’s Ruth and Lawrence Harvey Chair in Neurosciences.

“When I was a baby, my mom had a brain tumor and Dr. Black took it out, so he is important to me, not just as a historical figure or as an author, but because he saved my mom’s life,” said Jesse, 9, the son of Cynthia Burstein Waldman, 46, of Los Angeles.

Her tumor, technically, had grown outside her brain but inside her skull, along the hearing and balance nerves linking her right ear to her brain. Like all acoustic neuromas, it was not cancerous but had become dangerously large. Pressing into the brain, it blocked the normal flow of cerebrospinal fluid, causing high pressure in her cranium. It also pushed on the brainstem, which controls basic life functions.

Waldman’s symptoms started when she was pregnant – slight facial numbness, a little extra saliva when she brushed her teeth – but they were so mild she assumed they were normal. “They were all very intermittent. Nothing was serious. My obstetrician asked at some point if I wanted to see a neurologist and I said, `No, not if it’s going to go away,’ ” she recalled.

Six weeks after Jesse arrived, Waldman noticed her right ear wasn’t hearing his cries, and annoying headaches were becoming unbearable. After seeing an ear, nose and throat specialist who prescribed steroids for a possible sinus infection and scheduled a CT scan for a later date, she and her husband, Vince, took off for New Orleans to introduce the baby to family. But the headaches became excruciating, and when she returned and had the CT scan, the doctor took a look and sent her immediately to a neurologist, who sent her immediately to Cedars-Sinai. The chambers through which cerebrospinal fluid flows – the ventricles – were four times their normal size, and an MRI confirmed the presence of a very large tumor.

“If you have a smaller tumor, you have many options. I didn’t really have any options. Everyone agreed it needed to come out and it needed to come out now,” Waldman said.

Surgical removal of even a small acoustic neuroma is a challenging, painstaking and time-intensive procedure. The tumors occur in a narrow, bony tunnel -- the internal auditory canal. The dense bone is difficult to penetrate and the tiny canal is shared by the seventh and eighth cranial nerves, which control facial movement and expression, and hearing and balance. Damage to the nerves can cause permanent facial paralysis and hearing loss. Acoustic neuromas also grow near the brainstem, home to 12 cranial nerves, each responsible for crucial motor and sensory functions, such as balance and movement, sight, smell, swallowing and breathing.

As the couple began to realize the gravity of the situation, they sought advice from family, friends and doctors. “They said, ‘You want someone who is really, really skilled with a brain tumor.’ And when you’re in Los Angeles and you say ‘brain tumor,’ you hear ‘Keith Black,’” said Waldman, an entertainment law attorney who also chairs the board of the Hypertrophic Cardiomyopathy Association and suffers from the hereditary heart condition.

Black, who removed the acoustic neuroma in a seven-hour operation, said, “These larger tumors are obviously potentially life-threatening because of the brainstem compression and buildup in pressure. Even though they are benign, they can result in devastating consequences and death, but with appropriate surgery and management, a high number of these patients can be cured and resume a normal life, as Ms. Waldman has.”

Attending an acoustic neuroma meeting several years ago, Waldman met patients with severe facial paralysis and other serious maladies. She lost hearing in her right ear, which was expected, and has slight right facial weakness. “Unless I told you about it, you wouldn’t know,” she said.

Jesse has heard this story. When he was 3, he wanted to be a neurosurgeon.

“He’s moving into film directing now, but when he was 3, he would walk around saying he wanted to be a neurosurgeon and he was really into medicine for a while right before he started kindergarten. He loved science and medical textbooks. We were at a museum once and he spent hours looking at pictures of anatomy,” his mother said.

When Waldman was at Cedars-Sinai two years ago for a follow-up visit with Black, she noticed his book, “Brain Surgeon,” in the hospital gift shop. She bought a copy and asked him to sign it. The book resides on a shelf at home and when the school assignment came along, Jesse discussed it with his dad, Vince.

“I was trying to stay out of it a little bit. I didn’t want to push it. But Vince suggested it to him and I came home from work one day and they said, ‘It is decided: Keith Black,’” Waldman said. Father and son worked on the presentation. Mom helped with the surgical garb, which Jesse already owned since he was a surgeon for Halloween.

After the presentation, Waldman sent a picture of Jesse with his poster to Black, with a letter that reads in part: “You operated on me nine years ago by removing a large acoustic neuroma which was compressing my brain stem and causing hydrocephalus. At the time I was diagnosed, I was approximately 10 weeks postpartum and had recently delivered a son. … Fast forward to March, 2011. My son Jesse is now in the third grade at Westwood Charter School here in West Los Angeles. My husband and I, thanks to you, are living normal, if somewhat hectic, lives in our roles as attorneys and parents of a now nine-year-old son. … Attached hereto is a picture of Jesse with his poster. By the way, he received a perfect score on his presentation!”