"It's called a cavernous malformation or a cavernous angioma," says Dr. Ajith Thomas, chief of cerebrovascular surgery in the division of neurosurgery at Beth Israel Deaconess Medical Center. "It's a mass of thin-walled capillaries we find in the brain that looks something like a raspberry. While it may be an unfamiliar term to read in the sports pages, cavernous malformations are actually fairly common. Many times, they go undetected."
An undetected cavernous malformation is not necessarily a health threat. It's when those thin-walled capillaries rupture and leak blood into the surrounding brain structures that problems can occur. And the location within the brain often determines a course of action.
"Many cavernous malformations are 'silent.' They may leak a small amount of blood that gets reabsorbed or they don't leak at all and the patient is never aware," Thomas explained. "The leaks are also how the malformations grow, so if there are a series of small leaks, the structure itself may get bigger and the symptoms are more frequent. If the malformation is in the brain cortex, the symptoms might be dizziness or seizures. The frequency and severity of the symptoms are considerations when determining if surgery is an option. If we are talking about the cortex, it's a relatively simple surgery. If it's in the brain stem, it can be a much more serious matter."
Thomas informed me that the brain stem -- the lower stalk-like part of our brain that connects to the spinal cord -- is crammed with important structures that control breathing, heart rate and our ability to swallow. Westmoreland's cavernous malformation, discovered after he complained of headaches and other neurological issues, was in his brain stem.
"If a malformation in the brain stem bleeds again or begins to grow, the results can be devastating," said Thomas. "The surgeon who operated on Ryan, Dr. Robert Spetzler of the Barrow Neurological Institute in Phoenix, Ariz., is probably the world's best at this procedure. He has a tremendous amount of experience."
Less than a week after his five-hour procedure, reports were that Westmoreland was out of the intensive care unit and on to what could be a fairly long and difficult recovery.
"Surgery on the brain, no matter how well executed, is always going to cause some little deficit. We surgeons do what we can to keep that to the absolute minimum and hope that it turns out to be unnoticeable to the patient," he explained. "Recovery also depends in part on what you started with. Ryan is pursuing a career that demands exceptional coordination and skill, but he has the advantage of being young and in good physical shape, and that will help."
Thomas estimates that 1 to 2 percent of the population may have cavernous malformations and many, if not most of them, will be unaware and unaffected. It would be wrong to think of them as ticking time bombs.
"Honestly, it's not something I would worry about," Thomas said. "If there are no symptoms, there is no reason to go looking for malformations. Even when we find them, our first question is, 'Is the risk of damage from surgery greater than the risk of simply watching and waiting?' Often the answer is yes."
In Westmoreland's case, it was determined that it was necessary for a surgeon to step in. So for now, we hope that that good head is now even better, and we'll watch and wait for Westmoreland to step back into a batter's box.