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It was with hope and fear that RaeAnn Firek's parents sent their little daughter to the operating room in August 2002. What had started as little drips of blood on her baby sheets at 11 months had morphed into life-threatening nosebleeds by the time she was 3. After more than a year of operations to try to stop the bleeds, the Fireks, of Baldwin, knew they had reached the end of the line: Their daughter would die if the nosebleeds - which were an indication of a much greater problem - continued unabated. She was only 4. As RaeAnn was wheeled toward the surgical suite at Children's Hospital, Dr. Amin Kassam awaited her arrival with a similar mixture of hope and fear. He and Dr. Carl Snyderman were poised that day to do a brain surgery that had never before been done on a child. They would access the base of RaeAnn's skull through her nose. Ever since Snyderman first saw RaeAnn when she was 16 months, he and Kassam had been studying, researching and designing special instruments for such a surgery. RaeAnn's mother, Rhonda, recalls the day painfully well. "We didn't have a choice but to try the surgery. We knew what would happen if we didn't do it. I'm just so glad that [Dr. Kassam] was brave enough to do this."
UPMC Presbyterian’s Dr. Amin Kassam became As for RaeAnn, she became a formidable foe to the fierce nosebleeds that tried to kill her. The hemorrhages were caused by a problematic mass of arteries and veins at the base of her skull and behind her face. The tangled mass resulted in extremely high blood pressure at the site, causing the vessels to burst into life-threatening nose bleeds. It was Snyderman, 50, and his colleague Dr. Ricardo Carrau, 47, who pioneered the concept of accessing the brain through the nose. Kassam joined the team in the late 1990s. These three men, together with Dr. Michael Horowitz, 43, formed the UPMC Center for Minimally Invasive and Cranial Base Neurosurgery at UPMC Presbyterian. The center is the world's leader in this unique surgery, which is less invasive and infinitely less scarring than traditional brain surgery. Between the time doctors first saw RaeAnn at 16 months and then later at 4 years, the center's surgeons worked to develop the surgical technique. By the time RaeAnn was on the way to the operating room in 2002, the surgical team "had made a lot of progress, and we felt comfortable that we had the right equipment" and knowledge to fix RaeAnn's problem, Kassam says. In a series of three surgeries during 2002, surgeons closed off several vessels in the tangled mass. It worked. One artery that supplied blood to the vascular malformation had to be removed - it was also the artery that supplied blood to her right eye. As a result, RaeAnn is now blind in her right eye. But, she has perfect vision in her left eye with the help of corrective lenses, and has not had another serious nosebleed since the surgery. At 8, she is a bright and articulate second-grader in the Baldwin-Whitehall School District. As for what RaeAnn thinks about the entire ordeal? She gives a shy smile and says she remembers "the IVs and how I knew I was in trouble when I saw the big machines and big red doors" of the operating room. She still sleeps with a box of tissues by her bed - just in case - but her days are filled with school, friends, playing hide-and-seek and taking guitar lessons. And that suits RaeAnn - and her parents - just fine.
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The pairing of Kassam, a neurosurgeon at UPMC Presbyterian Hospital, and RaeAnn joined two extraordinary individuals. The 39-year-old Kassam became a brain surgeon after his family immigrated to Canada from Uganda in 1972. Kassam comes from a family of car mechanics, and he was one himself before becoming a neurosurgeon. His career choice stemmed from watching his mother live in a vegetative state for 13 years due to an inoperable brain tumor.
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