Precision medicine offers new hope for firefighter with rare brain tumor
(SACRAMENTO)
Ronald Von Scheele was used to battling major forest fires and covering steep terrain. At age 34, the firefighter never imagined he would be fighting for his own health.
But one night, he found himself in an ambulance, rushed from his local hospital in Lake County to UC Davis Medical Center, where he discovered he had a rare brain cancer. Luckily, he was in a place that could handle the complex, advanced care that he needed.
Road to finding the cause
Over the years, Ronald had fought some of the larger fires in Northern California, including the devastating LNU Lightening complex in Napa, Sonoma and surrounding counties. The work required him to be in excellent shape. But in 2023, something changed.
“I was probably the most fit I'd ever been in my life. I would carry heavy weight and get up steep terrain pretty quickly. And then, my health absolutely declined,” Ronald said.
He started getting pounding headaches that left him feeling “crummy and super fatigued.”
He thought it was dehydration or a potential neck alignment issue. “The headaches would happen often, especially after hikes in hot weather. But I realized that my peers weren’t having the same issues,” Ronald remembered.
With time, the headaches became more frequent and severe, his neck felt stiff, and he developed ‘saucer-like auras’ up in the corners of his vision.
“He was feeling very dizzy and nauseous, which were pretty new symptoms. That triggered me to be more on guard,” said Kelsey Von Scheele, Ronald’s wife. Kelsey, who is a nurse, could tell something was wrong with her husband.
Ronald and Kelsey Von Scheele looking forward to putting this health scare behind them.
It is all in your head
By June of 2025, Ronald’s stamina was decreasing and he was becoming more lethargic. His wife also noticed a slight personality change that she said “seemed like depression.”
On Feb. 23, 2026, Ronald returned home from a class feeling very tired, and by that night, he was in excruciating pain.
At 3:00 am, Ronald and Kelsey went to their local emergency department in Clear Lake, California. Imaging revealed ‘something was wrong,’ but clinicians couldn’t tell if it was a blood clot or a tumor on Ronald’s brain. The neurologist recommended Ronald’s immediate transfer to UC Davis Medical Center.
At UC Davis, an MRI showed a tumor with a cyst in the hypothalamic pituitary region that was putting pressure on Ronald’s brain and neck. He needed brain surgery.
Minimally invasive brain surgery
“The goal was to drain the cyst, remove some of the cyst wall to try to prevent it from filling back up again, and get a biopsy of the tissue that gave rise to the cyst,” said neurosurgeon Kiarash (Kia) Shahlaie, a professor and chair of the Department of Neurological Surgery and director of the UC Davis Center for Skull Base Surgery.
Shahlaie made an opening in the skull about the size of a dime. Through it, he carefully passed an endoscope (a camera on a stick) to the area where the mass was located. He drained the cyst and obtained a sample, or biopsy of the mass.
The pathologist on site examined the biopsy tissue in what is known as frozen tissue analysis.
“This pathology analysis during the operation is really helpful in providing us with a rough diagnosis,” Shahlaie said.
The team suspected Ronald’s tumor was a craniopharyngioma but did not know which type. The analysis confirmed it was papillary, helping them to decide on a course of treatment.
“Since that type of craniopharyngioma can be treated with medication, we did not need to take the risks of attempting a complete resection. Instead, we focused on making sure that there were no more cysts causing an obstruction,” Shahlaie explained.
The MRI images of Ronald Von Scheele’s brain show that before treatment (left), the tumor contained a solid nodule which was surrounded by a large cyst. Following treatment (right), the nodule is not clearly visible, and the cyst has substantially decreased in size.
Precision medicine guiding cancer treatment
Ronald’s tumor had a BRAF V600E mutation. The BRAF gene provides the blueprint for a protein that controls normal cell growth. The mutation results in uncontrolled cell multiplication, leading to a tumor.
“Papillary craniopharyngioma is a rare brain tumor. In Ronald’s case, the tumor was in a very challenging location, near the pituitary gland, hypothalamus and visual pathways,” explained UC Davis neuro-oncologist Orwa Aboud.
Aboud is an associate professor in the Departments of Neurology and Neurological Surgery. He is affiliated with the National Cancer Institute-designated UC Davis Comprehensive Cancer Center and specializes in treating patients with brain tumors.
Ronald Von Scheele during a follow-up visit with UC Davis neuro-oncologist Orwa Aboud.
Traditionally, treatment has relied on surgery and radiation. But in this case, Aboud suggested a targeted therapy to control what was left of the tumor and avoid — or at least delay — radiation and additional surgery.
“Molecular testing allowed us to identify a specific mutation driving Ronald’s tumor and select a treatment designed to target it. Our goal was to control the remaining tumor while potentially avoiding or delaying radiation therapy, which can have significant long-term effects given the tumor’s location near critical brain structures,” Aboud explained.
In April, Ronald started a combined BRAF/MEK targeted therapy (vemurafenib + cobimetinib) to target the BRAF mutation. Ronald’s subsequent imaging (MRIs) showed the tumor shrunk and there is a significant response to treatment.
“Ronald has responded well to treatment. He is currently neurologically stable and on a treatment holiday, with continued MRI surveillance to monitor for any changes,” Aboud said.
Ronald and Kelsey shared their appreciation for the caliber of care they continue to receive at UC Davis Health.
“Dr. Aboud calls to check on Ron. The personal touch has been fantastic throughout this journey,” Kelsey said.
Ronald still gets headaches occasionally. He is navigating some side effects of the treatment, such as acne and joint pain, but nothing unexpected. He is looking forward to hiking, kayaking, and hopefully, soon starting a family with Kelsey.
“Dr. Aboud did very well in explaining what our path would look like,” Ronald said. “I am hoping to go back to full duty and restoring normalcy.”
