Opera Student Recovers from Brain Surgery, Returns to Singing
Northwestern Medicine experts minimize impact of neurological surgery using advanced imaging techniques and brain mapping
To say singing saved 25 year old Sandra Marante’s life is no stretch; in fact, if you ask her, she’ll tell you it saved her twice. At 19 years old, Marante’s burgeoning career as a pop singer was abruptly halted when an accident at a Florida restaurant left her with severe burns. During months of rehabilitation, music served as her therapy and motivation to make it through the painful ordeal. One night, as she lay in her hospital bed, she found herself entranced by an opera performance on television. Inspired by the beauty of the soprano’s voice, she decided to leave the fast-paced world of pop music to pursue the artistry of classical music. That decision brought her to Chicago, where in 2010 she enrolled as a graduate vocal performance student at Roosevelt University’s Chicago College of Performing Arts (CCPA). While rehearsing in September 2011, Marante had a grand mal seizure and was rushed by ambulance to Northwestern Memorial Hospital. She was seen by neurosurgeon Bernard Bendok, MD, and neurologist Richard Bernstein, MD, who informed her the seizure was caused by an arteriovenous malformation (AVM), a neurological condition that occurs in less than one percent of the population, yet is a leading cause of stroke in young people.
“An AVM is an abnormal tangle of blood vessels in the brain which is often undetected, yet can be life threatening causing serious complications including stroke, brain hemorrhage or seizure,” explained Bendok, who is also an associate professor in neurological surgery and radiology at Northwestern University Feinberg School of Medicine. “In Sandy’s case, the AVM was located in her right temporal lobe, the area of the brain responsible for speech, memory and comprehension – all things that were vital to her success as an opera singer.”
Marante hoped the seizure was a one-time event, even telling her mother to remain in Florida after it happened. However, worry began to set in as she learned that without treatment the chance for long term seizures may be higher. Treatment would reduce the chance of seizure, but came with risk.
“My first concern was that my life may be at risk yet I also couldn’t help but wonder what this might mean for my singing,” said Marante.
Marante and her mother Maria, a classical violinist, quickly began researching the condition. They also consulted with Bendok and his colleague Hunt Batjer, MD, chair of neurological surgery at Northwestern Memorial and Northwestern's Feinberg School of Medicine, both of whom are recognized leaders in the treatment of AVMs.
“Treatment options for AVMs range from minimally invasive embolization and radiosurgery to resection with craniotomy, which is when a portion of the skull is removed to access the brain,” explained Bendok. “Each option has its benefits and risks, but for a young patient like Sandy, surgical resection is often the best option to fully cure the AVM.”
The family began to consider their options, yet continued to question what impact treatment would have on Marante’s memory and ability to sing. As an opera singer, she regularly had to memorize music and lyrics, often in languages there were not to her. Sharing their concerns, Bendok collaborated with Northwestern Medicine® neuroimaging experts who created a set of specialized tests to map her brain prior to surgery using functional magnetic resonance imaging (fMRI). Functional MRI is a relatively new diagnostic tool that measures changes in the active part of the brain.
“Functional MRI is commonly used for neurosciences research, but it’s still an emerging tool in a clinical setting,” said Todd Parrish, PhD, director of the Northwestern University Neuroimaging Research Laboratory, who created the tests. “With fMRI, we are able to create a map of the neural activity in the brain, which can be used to assess the risk of a brain surgery and plan the procedure in a manner which minimizes its impact and best preserves function such as speech, movement, and memory. In Sandy’s case, we took it a step further to personalize the tests in a way that we hoped would paint a clear picture for Dr. Bendok of how her brain worked when she was singing.”
Parrish developed a personalized set of tests for Marante by playing recordings of operas and asking her to visualize singing while she underwent the MRIs. Using the images, he created a map of her brain pinpointing the regions critical to her ability to sing, comprehend and memorize. Bendok then used the information to assess the risk and plan the surgery to best preserve those functions. Confident that the AVM could be removed without devastating her future ability to sing and perform, Bendok recommended Marante move forward with surgery because it would fully cure her AVM.
She underwent successful surgery in December, and in January received the go ahead from Bendok to resume singing. Marante has regular follow up appointments with her neurologist, Bernstein, but otherwise lives a normal, active life. She is preparing to graduate in May, after which she plans to audition for the CCPA-Chicago Opera Theater Professional Diploma Program.
“Through all of this, I learned that in life you need to find something that you’re really passionate about; for me that’s always been music,” said Marante. “Music kept me focused and inspired during all these tragedies. It always made me feel like eventually the storm would be over. Now I’m just focused on my future and seeing where I can go in my opera career.”
For Bendok, seeing his patient thrive doing what she loves is a testament to the work that he and Parrish do. “When Sandy came in for her follow up appointment and sang for the first time, that was a huge moment for all of us,” said Bendok. “To know that she has a bright future doing what she loves is the best result that I can ask for.”
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