The Verdict: Brain Surgery... Again

Well folks, the verdict is in… the next step is brain surgery... Again.

It was kinda funny to me that we drove 200 miles and 3 hours and only talked to my neurosurgeon, Dr. Lang, for about 15 minutes. He really didn’t sugarcoat it at all, which I appreciate. He just came out and said that it needs to come out. We asked about the trials that Dr. Conrad mentioned. The virus trial is only for patients that had a grade 3 Ependymoma that was removed and then came back. I only had a grade 2, so that one is out. The other two chemo treatments are done after removal of the tumor so we can't do those yet. He said that it is growing, and really needs to come out before it causes any damage.

There are both good and bad things:

• The bad? It’s freaking brain surgery people! There a lot of things that could go wrong.
• The worst? I could die. Just saying.
• The not so worst? I could lose movement and possibly feeling in my right leg forever, maybe my right arm and torso, and my speech center could be damaged.
• The best? I’m a little tired and weak at first but make a pretty good comeback.
• The bestest of all? I’m having my surgery at MD Anderson! It is one of the best, if not the premier cancer hospital in the world. That’s pretty awesome. (I hope my insurance doesn't disown me. Can they do that? Especially if it’s the government’s Tricare??)

First they have to look at the calendars to make sure all the staff are necessary available to perform the procedure. We’re currently looking at a time frame between Feb 22 and Mar 3. Incidentally, Mar 3 is the 5 year anniversary of my first craniotomy. Weird, huh?

Dr. Lang told us that because of the blood vessel that runs through the tumor they want to do a CT Angiogram; this will allow them to map the blood vessels in my brain so that they can see what this vessel might be feeding.

Next, they may do a portion of the surgery with me awake. They would start the surgery like normal, with me completely out, but then bring me out of anesthesia so that I could answer questions and they might also stimulate parts of my brain to see what happens to map it. I found an interesting excerpt from the Ohio State University Medical Center website in an interview with Dr. E. Antonio Chiocca, director of neurological surgery at Ohio State University Medical Center, regarding awake brain surgery:

Patients undergoing awake brain surgery are anesthetized just enough so they will doze during the incision in their skin and removal of a section of the skull. Anesthesia is then withdrawn and patients are coaxed into consciousness so they can speak during procedures on the brain itself.

“You need a very good team to do this. Neuroanesthesiologists give patients just enough medicine so they will sleep during the first phase, and then they will wake them up when we get to the brain,” Chiocca says. “We have a speech pathologist talk to the patient as we remove the tumor. If we notice any trouble speaking, or if the patient develops a halting pattern of speech, we know we’ve gone too far and we stop.”

"Though these brain centers are universal among patients, the mapping and imaging allow physicians to adapt to the “uniqueness of each brain,” Chiocca says. “And having the patient awake allows us to take care of individual differences.”

Patients who undergo awake brain surgery often are able to leave the hospital and return to normal activities within 48 to 72 hours.

Sleeping patients whose surgeries occur near these speech, memory and motion centers of the brain are at higher risk for suffering temporary or permanent deficits, but some patients will opt not to be awake, Chiocca says.

I am totally for being awake during the procedure if it helps them and gives me a better chance of coming out with less deficiencies.

MD Anderson BrainSUITE

Last, if they deem it necessary (I think it is, but that’s just me) they will perform the surgery in MD Anderson’s BrainSUITE. It is basically an operating room with an MRI machine in it so that the doctors can see what they are doing in real time. It helps them to see if they have removed the entire tumor before they end the procedure. In 2006, MD Anderson was the first hospital in the world to purchase and implement one of these systems. There are currently only six in the US. This thing is cutting edge and I hope that they decide to utilize this awesome technology.

• So how do I feel about all this? Well, I’m ready, I’ll tell you that.
• Is it scary? Yes, I’m not going to lie.
• What are my fears? I’m not afraid of death. These guys are going to take care of me and I know that’s not going to happen. But if it does, Holly and I have talked about the ‘ifs’ and there are some preparations we need to make. We’re not stupid. I mean heck, someone could trip over a cord in the OR and kaput, I’m toast. You have to think about these things!
• Am I worried about how it might affect my body? I’d be lying if I said no. But, if I survive and they get this monster out of me forever, no matter what deficiency I have, I’ll be the happiest man in the world. I’ll deal with it. I have learned how to live with limited mobility on my right side and I can do it again.

Dr. Lang said that I’d probably have to recover at MD Anderson for 3-5 days and could go home if there are no complications. If I do require therapy they have physical and occupational therapy in the hospital and could stay there for a few additional weeks if necessary. I’m looking forward to putting this all behind us and moving on. I’m tired of cancer lurking over me. I just want to give cancer the finger like my friend Eric did. No, really. He had cancer on his finger and they amputated it at MD Anderson. I’m not kidding. Well, I’m not going to give them my finger, but they can have my tumor, and just a little bit of brain tissue for clear margins. As soon as we have more info, we’ll let you know.

Thanks for reading and please continue to pray for me and Holly. We’ve got a lot going on right now, (Holly is having laparoscopy next Thursday) but somehow just being here together for each other makes it all better.

-Roger