Reviewing her MRI, Dr. Link finally gave Espinoza a diagnosis. She had a cerebral cavernous malformation (CCM), also called a cavernoma.

A cavernoma is a type of angioma, or a tightly packed cluster of small, abnormally shaped blood vessels. What distinguishes cavernomas from other angiomas is their location in any of several areas of the nervous system. Cavernomas — also known as cavernous malformations, cavernous angiomas, intracranial vascular malformations or cavernous hemangiomas — look something like a berry and can be as small as a quarter-inch or as large as 4 inches.

Cavernomas are surprisingly common and occur in about 1 in 100 to 200 people.

At least 30 percent of patients living with a cavernoma experience some symptoms — most are in their 20s or 30s. Another 25% experience no symptoms at all. Symptoms can be related to the part of the brain affected by the condition and may appear or subside as the cavernoma changes in size due to bleeding and reabsorption of blood.

Cavernomas that leak blood into surrounding brain tissue, like Espinoza's, can result in lasting neurological problems like:

• Balance problems
• Memory loss
• Headaches
• Seizures
• Vision problems
• Limb weakness
• Stroke

“Cavernous malformations that are deep in the brain, like hers, present a much higher risk of bleeding,” says Dr. Dehdashti. Espinoza’s imaging tests showed that she’d already experienced more than one small hemorrhage; the next one could be much more dangerous. Her cavernoma was dangerously close to brain regions responsible for her facial muscles, eye movement, hearing and physical coordination — a bleed could impact all of those or even leave her in a coma.

“The constant anxiety, not to mention the potential she faced for future damage, would greatly compromise her quality of life,” he says.

Surgery would be difficult, Dr. Dehdashti acknowledged. But he felt sure he could find a safe pathway to removing the cavernoma.

Espinoza knew she was facing a life-changing decision, but she felt no doubt. “I knew from the second he started speaking about it that I wanted to go through with the surgery,” she says. “If I left it alone, my risk of having another brain bleed would go up every year. I wanted my life back.”

Espinoza's surgery, which took place on June 23, 2022 at NSUH, took five hours and involved state-of-the-art tools. Guided by intraoperative brain-stem mapping, the surgical team used a probe to electrically stimulate nerves in order to identify the areas that controlled vision, speech and movement. This process helped them determine a safe route to the cavernoma.

In addition, Espinoza’s brain and cavernoma had been imaged in detail using a specialized CT scanner. The scans were uploaded into a workstation in the operating room, precisely lined up with bony landmarks of her skull, and projected in 3D onto her brain to help the surgical team locate the exact contours of the abnormal blood vessels.

Carefully, Dr. Dehdashti navigated under the surface of the brain stem to find the cavernoma. Then he dissected around it and took it out. It was almost an inch long — almost half the width of the brainstem in that spot.

When Espinoza woke from surgery, she asked about her cats — were they okay? “That was a great sign,” says Dr. Dehdashti. “She was speaking without any problem and showing no signs of damage.”

Still, she needed time to recover. She had double vision and her right side was weak and numb; her arm and leg didn’t work quite normally. This degree of temporary dysfunction was to be expected after such a delicate surgery. But within a day or two, she was walking the hallways of the hospital. On day three, she went home and within a week she was walking on her own.