Argentina Woman Travels to Barrow for Spinal Cavernoma Surgery

Eleven days after submitting her daughter’s medical information to Barrow neurosurgeons through the institute’s online Second Opinion Program, Teresa de Stefano of Argentina received what she called “magic words” from Dr. Michael Lawton. He believed he could safely access and completely remove her daughter’s cavernous malformation from her spinal cord.

“We never thought that a neurosurgeon of Dr. Lawton’s prestige would answer the second opinion,” de Stefano said.

A neurologist in Buenos Aires diagnosed then 28-year-old Ines de Achaval with the rare vascular abnormality in May 2018. It was located in the thoracic region, or the mid-back, from levels T5 to T7.

As a lawyer, de Achaval spends many hours sitting in front of a computer, so she didn’t think her back pain was anything unusual at first. Even the onset of leg weakness didn’t concern her too much. She hadn’t been sleeping well due to the back pain and was probably fatigued, she thought.

But she couldn’t dismiss the abnormal sensations in her leg, like stepping into a hot shower and feeling cold water instead.

‘It was crazy, at 28, to live with that time bomb’

Four doctors in Buenos Aires told her that while they would normally recommend surgery for a symptomatic spinal cavernoma, removing her lesion would be too risky; it was too big and too difficult to access. A hospital in the United States agreed. But one doctor in Argentina said the opposite: it was too risky to leave it alone.

Cavernous malformations are tightly packed clusters of tiny blood vessels that have thinner, weaker, and less elastic walls than normal capillaries. The capillary walls stretch out and form caverns that fill with slow-moving blood. They are prone to leaking and can bleed into surrounding tissue, causing neurological symptoms.

Ines' husband, Nicolas, puts a ring on her finger at their wedding ceremony. They are surrounded by family and friends.
When Ines de Achaval scheduled her surgery for August, she and her fiance, Nicolas, moved their wedding from September to June.

Some people with cavernous malformations may never have noticeable symptoms. Others may have deficits after a bleed that improve over time. But in some cases, repeated episodes of bleeding can cause permanent neurological damage.

“When I started having weakness, it was because I had a bleed,” de Achaval said. “The second bleed would be larger, and we didn’t know how I would recover from that. That was basically what made me think that this one doctor in Argentina was right and that it was crazy, at 28, to live with that time bomb in my back.”

The risks of paraplegia and loss of bladder control after surgery worried her, but she decided she’d rather take her chances with surgery than wait for a potential bleed that could cause irreversible damage.

Hope through Barrow Second Opinion

The mother of one of de Achaval’s friends is a doctor and started reading about cavernous malformations in PubMed, a database for biomedical literature. She came across Dr. Lawton’s name.

“Dr. Lawton seemed like the person with the most experience internationally in performing this kind of surgery, and I knew he had operated on many cases so that gave me reassurance,” de Achaval said.

De Stefano sent her daughter’s medical records and imaging through the secure Second Opinion portal in June.

“It was user friendly, transparent, and simple,” she said.

After hearing back from Dr. Lawton, de Achaval scheduled her surgery and traveled to Phoenix with her husband, parents, and mother-in-law. She met Dr. Lawton on Aug. 20, and he successfully removed her spinal cavernoma the next day. She woke up from surgery with paralysis in her left leg, but Dr. Lawton felt confident that it would be temporary.

“A couple days later, I started moving it again slowly, muscle by muscle,” she said.

De Achaval began neuro-rehabilitation at Barrow to regain leg strength and function. She was ready to return home to Buenos Aires three weeks after the surgery.

“It is so gratifying when patients who are told that their lesions are inoperable find Barrow and have successful surgery here,” Dr. Lawton said. “Not only does their experience lead to the cure they were after, but it becomes this emotional swing that is so positive for all of us.”


Reaching Milestones through Rehabilitation

De Achaval continued her rehabilitation in Buenos Aires at a neurological institution called Fleni. She began with five days a week, but she has been able to reduce that to two and return to her job.

In December, she traveled to Scotland and England for vacation and was able to sightsee on foot. On Feb. 10, de Achaval reached another milestone in her recovery: she went wakeboarding on the Parana River. It was the first time she’d successfully returned to a sport since the surgery.

“It was an amazing and extremely emotional moment,” de Stefano said.

De Achaval still has other goals, mainly running and skiing, but she feels grateful to be able to lead a normal life and said undergoing surgery with Dr. Lawton is the best decision she’s made.

“Ines is a wonderful patient—young, beautiful, vibrant,” Dr. Lawton said. “To be able to be her neurosurgeon, help her through this chapter in her life, and hear that she is wakeboarding again was a true joy.”

To request a neurosurgical second opinion or learn more about how it works, visit our secure Second Opinion portal.