Headache 9-1-1

"I believe a lot of divine intervention led Dr. Limonadi and me to come together last November. I owe my him my life."-Geoff Raya
RIVERSIDE COUNTY SHERIFF’S DEPARTMENT Chief Deputy Geoff Raya, 48, had been enduring severe headaches for about three years, managing them with medication prescribed by his doctor. One day in the fall of 2017, after leaving a meeting in Palm Desert, he felt another headache coming on, but didn’t have his medication with him. He called his wife.

“She advised me not to drive until the headache and nausea subsided,” the Rancho Cucamonga resident relates, so he pulled off the I-10 freeway, parked at a gas station, reclined his seat and, before closing his eyes, let his wife know where he was.

“Five minutes later, there was a knock at my window,” he continues. “It was a deputy from the sheriff’s station I’d just left. My wife had called the department, saying that I didn’t sound right on the phone, so they sent a unit to look for me. Shortly after they found me, an ambulance pulled up, and they took me to the emergency room at Eisenhower Medical Center.”

Raya explains that he hadn’t really been concerned about his headaches. After undergoing successful treatment for testicular cancer when he was 38, he’d had regular follow-up evaluations, including imaging, in subsequent years.

“Since that testing never revealed any problems, I didn’t think the headaches were anything to worry about,” he says.

Nor did the headaches slow him down. Raya has had a successful, nearly 25-year career in the sheriff’s department — holding posts as varied as working in corrections, to arresting drug dealers, to his current position overseeing administrative functions such as dispatch, workers compensation and the department’s computer system. At age 40, he took up running; since then, he has completed 25 marathons and more half-marathons than he can count — the last one just a week before he ended up at Eisenhower.

“When I got to the emergency room, they immediately wanted to do a CT scan,” Raya says. “I said ‘sure, go ahead,’ even though it had only been about 18 months since my last one. So I really didn’t expect any revelation from the test.

Imaging reveals massive brain tumor

“I was waiting around for results in the emergency department with my colleagues and my wife — who’d made it from Rancho Cucamonga in short order — and the doctor came in, put up an image of my skull on the light box, and pointed to this large tumor in my head,” he says. “I was floored. Speechless. I just had no expectation that anything bad would happen with all the follow-up after my bout with cancer.”

Board Certified Neurosurgeon Farhad Limonadi, MD, director of neurosurgery at the Eisenhower Neuroscience Institute, was called in for a consultation.

"I feel privileged to be part of the process to deliver him back to do what he does to work against darkness, what he's meant to do on this earth. This give meaning to my life. That's why I'm here."- Farhad Linonadio, MD
“When I looked at Mr. Raya’s images and at him, it was difficult to believe it was the same person,” Dr. Limonadi recalls. “In fact, I looked back and forth several times — he looked so strong and healthy compared to what his MRI suggested he should look like.” The imaging revealed a 4.4 by 4.7 centimeter tumor — nearly two by two inches — in the left lateral ventricle of his brain. There are four interconnected ventricles (cavities) in the brain, which is where the cerebrospinal fluid is produced.

“This tumor was pressing on delicate critical structures, obstructing the normal passage of cerebrospinal fluid — a condition called obstructive hydrocephalus — and causing intracranial hypertension,” Dr. Limonadi explains, referring to increased pressure inside the skull. “This could have been fatal if Mr. Raya did something as simple as put his head down or lay down to sleep.

Several surgical options, none without risk

“While the tumor was, fortunately, benign — it is what we call a grade 1 astrocytoma — removing it was incredibly complicated because of its size and where it was located,” Dr. Limonadi continues. “There were several approaches we could take, but each had significant risks.”

One option, going through the middle frontal gyrus — a region of the brain that’s part of the frontal lobe — would mean going into and through the brain and left ventricle to access the tumor, and could cause significant injuries to Mr. Raya’s brain and his ability to function normally.

While an endoscopic approach would be less invasive, the tumor was too massive to be removed through a tiny incision.

A third option — called an inter-hemispheric transcallosal craniotomy — involved entering the brain from the top of the skull, separating the brain’s two hemispheres, and going through that natural boundary to reach the lateral ventricle where the tumor was located. It also involved going through the corpus callosum, a broad band of nerve fibers joining the two hemispheres of the brain.

Once at the site of the tumor, Dr. Limonadi would decompress the mass, establishing a border between the tumor and the critical structures it was pressing on, and then remove it.

“The left cerebral hemisphere controls movement of the right side of the body, which was Mr. Raya’s dominant side,” Dr. Limonadi explains. “Because I would have to slightly retract the left hemisphere, this could cause some transient functional loss or motor skill impairment of the right side of his body, and loss of speech.

“We were confident that these impairments would be temporary,” Dr. Limonadi says. “Mr. Raya and his family were fully informed, and understood that this was the best option, even with the risks involved,” he adds.

MRI scans show the location and size of Raya's tumor and the difficulty it presented in removing

“Being presented with all these options — including doing nothing — I never deviated,” Raya affirms. “I just wanted the tumor removed.”

A successful surgical outcome

From Eisenhower’s emergency department, Raya was admitted to the hospital on November 15, 2017, and his operation scheduled for November 22.

“I had a week to stew about what I was going to be like after the surgery, and I got into a pretty depressed state of mind,” Raya admits. “The morning of surgery, I was in the pre-op area with my wife and 17-year-old daughter, and I was in full-panic mode.

“But then, all of a sudden, I entered a complete state of peace,” he continues. “A lot of that had to do with Dr. Limonadi, and the conversations I had with him leading up to the surgery. I felt confident that he’d do everything he could for me, and it was very comforting. I had a premonition that everything was going to be fine.”

And it was.

“We were able to remove the entire tumor,” Dr. Limonadi says. “Postoperatively, Mr. Raya had a hard time speaking — as expected — but he started improving from day one. And his post-op MRI showed there was no residual tumor and complete resolution of the hydrocephalus.”

Raya says he still experiences some occasional mild speech deficits — a slight slurring of words or stuttering — but it’s unnoticeable to anyone who doesn’t know him well. And it’s improving all the time.

After a total of three-and-a-half weeks at Eisenhower, and one-and- a-half weeks at a rehabilitation hospital, Raya was discharged to go home.

“Even as fit as I was, I was so de-conditioned from my lack of mobility during my hospitalization that my muscles atrophied,” he says, explaining his need for rehab. But he regained enough strength to walk out of the hospital, calling that his “first victory."

He’s racked up several more

“I was impressed with my healing,” Raya says. “I was back to work in four months, and back to running in two-and-a-half months. In fact, I’ve run two half-marathons since my surgery. Now my goal is to run another full marathon.

“You’re not done yet”

“I’m also trying to interact with as many people as I can who are suffering from cancer or brain tumors, and use my experience to help them in some way,” he says. “And here’s what I say to them: Search for the meaning behind what you’re going through, how you can benefit from it, and how you can use the situation to help others,” he continues. “You’re not done yet; there are things you still need to accomplish.”

Dr. Limonadi demonstrated this to Raya in a poignant way after his surgery.

“During one of my recent follow-up visits, Dr. Limonadi arranged for me to meet another patient who’d had a brain tumor and was six years out from his surgery, doing really well,” Raya says. “It was his way of saying, ‘This will be you in six years.’ It demonstrates his sensitive, caring side; he has incredible emotional competence.

“I believe a lot of divine intervention led Dr. Limonadi and me to come together last November,” Raya adds. “I owe him my life.”

“Mr. Raya is a member of society who has dedicated his life and places it in danger for the safety and well-being of others,” says Dr. Limonadi. “It is very clear to me that he’s not in the police force for anything other than to help others and work on behalf of light. I feel privileged to be part of the process to deliver him back to do what he does which is to work against darkness, what he’s meant to do on this earth.

“This gives meaning to my life,” adds Dr. Limonadi. “That’s why I’m here.”

For more information about Eisenhower Neuroscience Institute, please call 760.837.8020.

Eisenhower Neuroscience Institute

Eisenhower Neuroscience Institute specializes in advanced surgical and non-surgical treatment for a wide array of spine and brain disorders. With a collaborative, interdisciplinary team of board certified neurologists and neurosurgeons, and today’s most sophisticated diagnostic and treatment technologies, the Institute provides high-quality care on par with academic medical centers virtually anywhere in the nation — right here in the desert.

“There is a high cost associated with acquiring the latest technology and providing complex care to patients with neurological disorders,” says Neurosurgeon Farhad Limonadi, MD. “Eisenhower Health’s leadership is dedicated to excellence, and their backing enables us to deliver the best possible care, acquiring state-of-the-art equipment for such capabilities as neuroendoscopy, fluorescence-guided surgery and computer navigation.

“Our other major asset is our people, from the administrators to the providers, whose expertise makes the Institute the center of excellence that it is,” he adds.


Eisenhower Neuroscience Institute treats a full range of neurological disorders, from routine to complex, including:
• Brain tumors
• Skull-base tumors
• Degenerative diseases of the spine
• Chronic back pain
• Stroke (ischemic and hemorrhagic)
• Vascular disorders
• Alzheimer’s disease
• Parkinson’s disease and other movement disorders
• Aneurysms
• Arteriovenous malformations
• Trigeminal neuralgia and facial pain


Comprehensive diagnosis and treatment for a full range of neurological disorders include:
• Neurosurgery
• Cerebrovascular neurosurgery
• Endovascular neurosurgery
• Deep brain stimulation
• Stereotactic radiosurgery
• Neurointerventional radiology
• Artificial spinal disc replacement
• Image-guided spinal navigation
• Spinal reconstruction due to failed surgery, cancer or trauma
• Spinal surgery and reconstruction including instrumentation and fusion
• Pain management
• Rehabilitation