brain updates
Yesterday we had appointments with the radiation oncologist and the neurosurgeon who will be working together to take the tumor out of my brain. According to the opinions of all the doctors inolved (including Dr. Einhorn, the oncologist I saw in Indianapolis who administered and oversaw the high-dose chemo, stem cell transplant and RPLND surgery), gamma knife surgery is the way to go if we want to go after this thing. The other options include whole-brain radiation and a craniotomy. Whole-brain radiation might be a good choice if I had multiple lesions in my brain, but would require several treatments and is much more damaging overall. A craniotomy, according to the neurosurgeon, would work well in my case because the tumor is on the periphery of my brain and appears as though it would be easily excised. Of course, it also involves actually cutting open the skull, which brings its own set of risks, including infection. Both whole-brain radiation and a craniotomy would also require longer recovery times. Gamma knife usually
So the consensus amongst the doctors that I’ve spoken to is that gamma knife is the way to go for me. If for some reason the gamma knife isn’t completely effective, the neurosurgeon can go in later and perform a traditional craniotomy to resect any tumor that remains.
After looking at the MRI, the radiation oncologist thinks that there might be a second, much smaller tumor forming further back on the left side of my brain. She is relatively certain that it’s just a blood vessel, but they’ll do another MRI with double the ordinary dose of contrast before the surgery to be sure. But if it does turn out to be another tumor, they’ll change the surgical plan in order to hit both the tumors one after the other. She also said that they found some swelling around the site of the tumor, and they’ve started me on steroids to keep it under control. The gamma knife may produce more swelling, but they’ll keep me on the steroids for a few weeks after the procedure to try to minimize that.
Aimee and I went down to the hospital today to tour the gamma knife facility and get an orientation on the procedure. We have to be at the hospital on Friday morning at 5 am to register and check in. They’ll draw blood and run some tests before they send me to the gamma knife unit. When the neurosugeon arrives, he’ll inject me in four places with anesthetic before securing an alloy frame to my skull with screws. Then they’ll take me for a set of MRIs with the frame attached. The frame will allow them to determine the exact placement of the tumor within my skull for precise targeting during the procedure.
When the images from the MRIs are ready, the radiation oncologist, neurosurgeon, and physicist will develop the plan for the procedure. The planning stage could take a few hours, but when it’s done, they’ll plug me into the the machine and start the procedure. They said it would probably take about an hour (maybe a little more or a little less) to do the surgery itself. Afterwards, they’ll remove the frame from my head and take me to recovery. After about an hour or a little more in recovery, they’ll send me home. All in all, it looks like I’ll be at the hospital for about 10-14 hours.
Today we went to back to the radiologist for CT scans of my chest, abdomen and pelvis to see what else might be going on. She said that she should have a full report for us tomorrow, but right now it doesn’t look like there’s anything new anywhere else. Which is obviously good news. But we won’t know for sure without more blood tests after the gamma knife and possibly a PET scan.