In March 2022, 23-year-old Chloe Hermansen experienced an unusual sensation: she felt her heartbeat in her right eye.

Having suffered from migraines since childhood, attributed to a rare blood vessel malformation diagnosed when she was just five, the new symptoms were alarming. Chewing became painful, and even lying down was uncomfortable, making everyday life unbearable.

With no relief from doctors, Chloe left her job as a stylist in Dallas and moved back in with her mother in Missouri.

“It was disheartening. I felt like I lost myself, unable to do anything,” she shared.

That summer, after enduring months of pain, she discovered a specialist at Northwell Lenox Hill Hospital in New York who focused on her type of venous malformations. When her medical scans reached New York, doctors were stunned by the findings.

Doctors discovered that the skull bone behind Chloe’s right eye was completely missing, creating an opening that allowed her brain to press against her eye. This accounted for the pulsating sensation, explained Dr. Netanel Ben-Shalom, a neuroplastic surgeon at Northwell.

Over the years, the persistent pressure from the malformation had eroded the bone entirely, similar to how water erodes rock.

“Imagine the eye as the basement and the brain as the upper floor; she essentially had no ‘floor’ underneath,” Ben-Shalom noted. “The brain had sagged down toward the basement.”

Understanding Venous Malformations

A venous malformation is made up of abnormal veins usually found in the facial or neck regions, according to Dr. Teresa O, a facial plastic and reconstructive surgeon at Northwell.

“It resembles a tangled mass of worms,” she described.

These malformations are uncommon, impacting up to 1 in 5,000 people, as stated by the Cleveland Clinic. The exact cause is often unclear, but in Chloe’s situation, doctors believed she was born with it.

Most venous malformations are viewed as non-cancerous. If they are small and don’t create issues, doctors may opt for careful observation rather than immediate treatment.

In some cases, patients might receive sclerotherapy, where medication is injected directly into the malformation to reduce its size or close off the abnormal veins, as explained by Cincinnati Children’s Hospital. Chloe underwent several rounds of this treatment during her teen years but saw no results.

When Chloe finally consulted Dr. O, her veins had expanded and invaded nearby jaw muscles on the right side of her face, from her cheekbone up to her temple.

Had the condition remained untreated, there was a risk of cognitive decline and potential vision loss, noted Ben-Shalom, who understood the complexity of her treatment.

Surgery and Recovery Journey

Chloe’s first surgical procedure occurred in December 2022. Dr. O removed the affected muscles, fat, and the venous malformation itself, replacing the tissue with a graft taken from her abdomen, while contouring her cheekbone to align with the left side of her face.

Following that, it was Dr. Ben-Shalom’s turn to fix the gap in her skull.

His team created a 3D model of her skull, allowing them to produce an implant specifically tailored to fit the missing section. The final surgery was scheduled for March 2024.

During the final surgery, Ben-Shalom repositioned the brain away from her eye socket back into its proper place, excised the decayed bone influenced by the malformation, and fitted the skull with the 3D-printed implant.

Since her surgeries, Chloe’s previously “excruciating” pain has completely subsided.

Currently recuperating at her mother’s home in Missouri, Chloe looks forward to returning to Dallas in the next month. She’s eager to get back to work and resume her usual activities.

“I feel like I’ve been given a new lease on life,” she expressed.