Mischelle Colby is a person who likes to know what’s going on, and she’s very comfortable being in charge. In early 2025, life was pretty normal for her, her husband, and their two children, a daughter nearly finished with high school and a son in his early 20s. Mischelle was working at her dream job, a position she started back in 2017, performing assessments for the Salt Lake City School District.
A few years earlier, when COVID hit and upended everyone’s lives, including the Colbys, Mischelle found herself struggling with long COVID. Symptoms like severe fatigue, vertigo, migraines, and brain fog were a challenge to overcome. Eventually, she got back to a mostly normal routine, but the migraines lingered.
Recently, the frequency of Mischelle’s migraines increased, coming two or three times a month with symptoms lasting several days. She sought treatment at University of Utah Health and, while trying to find some relief, noticed hearing loss in her left ear. Doctors ordered a magnetic resonance imaging (MRI) scan, which revealed a brain tumor, the likely culprit of her persistent symptoms.
“I remember getting the test result in MyChart about a vestibular schwannoma. My coworkers and I started researching online...It seemed pretty bad, so I wanted a couple of days to process the information before reaching out to my doctors.”
When she did, doctors immediately referred her to Neil Patel, MD, a neurotologist and skull base tumor surgeon at University of Utah Health. “Mischelle was diagnosed with the most common lateral skull base tumor, a vestibular schwannoma or acoustic neuroma,” Patel says. “These tumors are benign, but they grow in the area between a person’s brain and ear. While they don’t spread like cancers, they exert negative effects through pressure on the brain and nerves. As larger tumors grow, patients often experience symptoms like headaches, hearing loss, vertigo, and dizziness.”
In rare cases, a vestibular schwannoma can be caused by an underlying genetic condition, but for most people it occurs by random chance, Patel says. They most commonly occur around age 50 but can appear in a person’s 30s or 40s. With these slow-growing tumors, a person may have the condition for an extended time before any noticeable symptoms.
“Generally, one of the first symptoms that people notice is asymmetric hearing loss,” Patel says. A person who goes to an ear, nose, and throat (ENT) doctor with this symptom is often referred for an MRI, which can reveal the presence of the tumor. Other early symptoms may include tinnitus (ringing in the ear), dizziness or vertigo, headaches, or facial numbness.
For Mischelle, the first glimpse of “Schwanny the brain meatball”—a name she jokingly uses to refer to the tumor growing behind her ear—came in those initial MRI results. The time between opening her results and meeting with Patel spanned a little over a month, during which Mischelle spent a lot of time researching the condition, the potential outcomes, and the most qualified doctors. When the appointment came, she was fully prepared.
“I wanted to know all the terminology and anatomy before meeting with the doctor so I wouldn’t feel so overwhelmed and be able to understand what we were talking about,” Mischelle says.
“Dr. Patel was absolutely amazing. He sat down and we just had a conversation. I asked all of my questions, we discussed my treatment options, went over the pros and cons, and together we made the best decisions for my case. After my appointment, I knew my brain was in good hands.”
For Dr. Patel, Mischelle’s extensive knowledge of the condition and treatment options was a surprise. “She was really well informed when she came into the appointment,” he says. “She had already discovered a lot of online resources—including my social media accounts with videos about the condition—and was prepared to discuss all her treatment options.”
Those options include a wait-and-see approach, which is best for smaller tumors discovered early or for patients who may not be good surgery candidates; radiation treatment that may help stop the growth of the tumor; or surgery to remove it. The surgical option was best for Mischelle, but it did come with risks. Skull base tumors grow in an area surrounded by cranial nerves that control facial sensation and movement, voice, swallowing, and shoulder mobility.
After weighing her options with her care team, Mischelle decided surgery offered her the best path forward.
Surgery begins with a craniotomy—a small window in the bone of the skull—followed by opening the lining around the brain (the dura) to get to the tumor.
Once inside, Dr. Patel found that Mischelle’s facial nerve was very spread out due to tumor growth, and he and William Couldwell, MD, PhD, Professor and Chair of the Department of Neurosurgery U of U Health, would have to meticulously excise the tumor.
“Dr. Couldwell is one of the most experienced schwannoma surgeons in the world,” Patel says. “It’s great to be able to work with him and his partners in perfect harmony.”
In this high-stakes surgery, even a small amount of damage to her nerves could leave Mischelle with facial paralysis, and the full extent of those side effects wouldn’t be clear until after she came out of anesthesia. “We use a specialized neuromonitoring and anesthesia team to make sure that we can monitor brain, spinal cord, and cranial nerve function during the operation,” Patel says, “which is vital to a good outcome.”
For skull base tumors in general—and especially ones like Mischelle’s, which was intertwined with cranial nerves—the experience of a skull base team matters.
“There’s significant evidence that for a condition as complex as this, patient outcomes are highly correlated with the experience of the center performing the surgery and the volume of cases the surgeons see every year,” Patel says.
“We see a couple hundred patients with skull base tumors every year. While not all of them need surgery, we do perform a lot of surgeries, know how to manage complications if they arise, and support patients through their recovery. A lot of it is about careful decision-making because no two tumors or patients are treated exactly the same.”
After surgery, patients spend two to five days in the hospital so doctors can monitor for exceptionally rare complications like bleeding around the brain, strokes, seizures, infections or fluid leaks that could lead to meningitis, or more short-term recovery challenges like difficulty walking, dizziness, and headaches or pain. Most of these complications are rare, but some could be life-threatening.
Fortunately, when Mischelle did wake up from the nine-hour surgery, she had normal facial nerve function. But because of the size of the tumor, her hearing in that ear was sacrificed. Mischelle needed a muscle graft in her dura lining and a lumbar drain to promote healing of the dura, so she spent five days in the intensive care unit (ICU)—and remembers the first night after surgery as one of the worst of her life.
“You are so dizzy, your head hurts, you’re coming out of anesthesia and not feeling well,” she says. “I had IVs in both hands and my ankle, a lumbar drain and an arterial line, just hoses and tubes everywhere. Every time I moved, the pain was excruciating and the nausea was overwhelming. The incredible nurses in that ICU are the only reason I got through that night.”
She spent another two days in the hospital before being discharged and going home. Perhaps the hardest part, as a mom with a teen and a young adult at home, was that life in general didn’t stop.
“My life was on pause for this major surgery and recovery, but for everyone else, life had to continue,” Mischelle says. “We were so lucky to have family and friends who really stepped in and helped us fill the gaps.”
Once home, she completed vestibular rehabilitation therapy, which aims to help patients recalibrate the brain to improve coordination and balance and reduce dizziness. Someone suggested that Mischelle document her recovery; she would almost certainly feel defeated and want to give up at some point, without realizing just how far she had come in her recovery.
“I had difficulty making new memories,” she says. “It was hit or miss whether I would remember something. But now I go back and look at the things I documented, and I can clearly see how much better I am from even a few weeks ago. Seeing the progress keeps me going.”
Mischelle is learning to adapt and give herself grace. She went back to work in August 2025, and her coworkers are extremely accommodating, reminding her to take it slow and facilitating “brain breaks” after cognitively intense activities. Things that require a lot of mental focus leave Mischelle physically tired, and if she pushes too hard, her brain just stops—a “forced rest,” she says. Those usually take about 20 minutes to recover from. She’s learning to recognize the signs of nearing her threshold and take a break before that happens.
“Mostly I have just learned to slow down, pay attention to my brain and my body and the signals that they are giving me, and remember that I am still healing,” Mischelle says.
The initial three months after surgery were intense, with recovery happening rapidly. But her Facebook friends who have been through skull base tumor surgery were quick to let her know that full recovery could take a year or more.
Some things will never go back to the way they were, and she’s learning to adapt to that as well. She has to be careful bending over for too long to avoid fluid rushing to her head, creating excess pressure and headaches. When she notices any changes in her health, she is quick to check in with her doctors. Going from “everything is normal” to “you have a brain tumor and need life-changing surgery” in the span of a few weeks was jarring. But through it all, Mischelle remains positive.
“In the 10 weeks between diagnosis and surgery, it was like being on a rollercoaster,” Mischelle says.
“Sometimes I was positive and could say ‘I can do this,’ and other times I just curled up in my bed and cried because I didn’t know if I really could do it or what my future would look like. Your whole life narrows down to what is really important.”
But Mischelle is also a very upbeat person by nature. “Whether you’re looking for the negative or the positive, you will find it,” she says. “I try to make the conscious decision to recognize that even though my situation is not the one I would have chosen, I can still celebrate the wins no matter how big or small. I can also find humor in most things—if I tip over or run into a wall, I tell people I was just dancing or needed to check out that really nice wall. Laughter really is the best medicine! I still have hard days, but I try not to let them get me down.”
Through it all, U of U Health doctors, nurses, and staff members have been there to help her. After the surgery, Mischelle remembers telling Dr. Patel, “That was just a single day of your life, just one surgery among thousands in your career. But for me, that one day affects every day for the rest of my life. Thank you for taking the time to do your very best for me on that day.”
“The impact those people have, even if it was just one nurse who was on a 12-hour shift in the ICU, that was a critical 12 hours of my life when I couldn’t take care of myself and I needed them,” Mischelle says. “Every person on my care team has been absolutely amazing.”
