My lil’ meningioma

After my routine MRI last year, the resulting report noted at the bottom that what was previously thought to be a white matter lesion along the right, front part of my brain, consistent with MS, was actually slowly growing larger and thus more likely “a small meningioma.”

After my routine MRI last year (8/17/2010), the resulting report noted at the bottom that what was previously thought to be a white matter lesion along the right, front part of my brain, consistent with MS, was actually slowly growing larger and thus more likely “a small meningioma.”

My new neurologist wanted me to have another MRI, at her facility, which I did on May 4th, and then OH and I met with a neurosurgeon to review these scans.  He told me that yes, it definitely looked like a meningioma.

[I asked if he really could tell it was a benign tumor without doing a biopsy and just by looking at it; he assured me that he could—something to do with smooth versus jagged edges, etc.]

He suggested that I not wait until it got any bigger to decide what to do about it.

[I asked if I would for sure have to deal with it eventually; he replied that yes, since we knew without a doubt that it was growing, albeit slowly, sooner or later I would have to deal with it.]

His recommendation was that I have one-time, outpatient radiosurgery, a “Gamma Knife treatment,” while it was still small enough to do that; otherwise, once it got bigger, he’d have to open up my skull and remove it. Brain surgery!

So that’s what we decided to do (and by “we” I mean “me”!).

The night before, I agreed not to eat or drink anything after midnight. Early the next morning, we arrived at the hospital, I in my wheelchair, wearing loose, comfortable sweats and carrying my morning meds and vitamins. 

The nurse that we had met the day before now met us at the procedure area and reviewed my various pills, then told me I could have something to eat after the head frame was attached, and I’d had the MRI that would show doctors exactly where to aim the lasers.  I could take them at that time.

In Gamma Knife, a frame of aluminum alloy is attached to the head, which looks heavy and a little scary [see pictures below; I tried to get the pictures of myself taken with the nurse’s cell phone, but these give you an idea].  But the skull itself is not drilled into, just drilled up to, and the frame is only about 6 lb.

 

 

1. Head Frame for Radiosurgery

2. Head Frame Attached to Live Person (not me!)

 

Before attachment of the frame, an intravenous (IV) line was inserted at my left wrist, and I soon felt very calm, warm and relaxed.  Ah, the Ativan® fog.  Good stuff.

Next I received four injections of a local anesthetic, two in either side of my forehead and two through my hair in the back of my head to numb the spots where the frame would be attached to my head.

This was when it became more traumatic for OH than for me.  He was watching me, observing all the shots, but once injected just under the skin, the anesthetic made golf-ball size swellings at each injection point.  He was morbidly fascinated but couldn’t tear his eyes away. [I got the story later but at the time was in a blissful haze, feeling little to no pain.]

Then the frame was attached and the pins that held it on firmly were tightened by hand. [I guess some doctors use a small drill but my nurse said the sound of it caused some patients anxiety.  Imagine that!]

Once the frame was secured in place, I was wheeled upstairs to an MRI machine and got a quick scan.  This picture and precise measurements were taken to pinpoint the location of the tumor.

 So after going for the scan, I was wheeled back to the staging area to eat, drink and nap until it was show time.   Since I was the only patient scheduled for Gamma Knife that day, OH was offered the second bed in the staging area, and since we’d been up so early that morning, we both drifted off to sleep almost immediately.

Meanwhile, my medical team – including a physicist! – were working together to determine the appropriate radiation dosage and develop a computerized treatment plan.  When they were done, the nurse came back to get me. It was “show time.”

I was wheeled into the treatment room, transferred myself to the unit’s bed and my head frame was locked into position.  The nurse had explained that while the machine looked like an MRI machine, the actual procedure was so quiet that patients often asked, when told it was over, “Did you even do anything?”

Now, she leaned over me and said, “What kind of music do you like?”  We settled on The Beatles and she told me I’d be lying down for about 45 minutes, but that there was a microphone through which I could talk to my doctor, so if I needed to take a break, to just let them know.

She started the music, left the room, and I drifted in and out of Beatles’ songs for 45 minutes.  I never needed a break.

Then she was back, helping me transfer myself back to the wheelchair, and wheeling me back to OH in the staging area.  The head frame and the IV were removed and there was minimal bleeding from the pin sites in my forehead but I shouldn’t get them wet for 24-48 hours.

Before we left for home, she admitted to me that there was a small chance that a bit of my hair in the front would fall out temporarily a few days after the procedure but that it would grow back.  As far as required pain medication, she and the doctor both told me that I shouldn’t need anything stronger than regular ibuprofen.

She also told me that, in the remotest possibility some healthy tissue was also damaged by the radiation, losing its ability to regulate fluids, for example, the neurosurgeon might prescribe a mild steroid to treat. We should keep an eye out for mood changes or sudden bouts of irritability that might indicate that. 

Yeah, right.  Like I’d be able to tell the difference. :) 

We were home by 4:30 that afternoon wand I had taken the next day off from work just in case.  I slept soundly that night and the next.  I had a little headache pain the next morning but nothing since, and sure enough the ibuprofen handled it.  So that was my big adventure last month.

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