2nd meeting w/ Neurosurgeon #1 to discuss surgery

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We met with:

Dr. Neil Martin
Nurse: Jennifer

Here's the results of our conversations:
Looked at 1st and 2nd functional MRIs. There is one area near (but not right next to) the tumor that is close to the reading and auditory function areas of the brain.
Looks like a tumor that originated in the brain rather than come from somewhere else; however, the CT scan, did show something on the lung that should be investigated first, before coninuing with the brain tumor surgery plans.
There are basically three choices that we could make about how to deal with the brain tumor:
1. Assume it is a tumor, treat with radiation which could be non-invasive. This is not necessarily the best option, because you can't be certain about what kind of tumor it is, because there is no biopsy to determine.
2. You could biopsy it first; however, there are risks of bleeding involved with this procedure.
3. Go ahead and remove it with a crainiotomy to remove most or all of the tumor.

Dr. Martin's strong recommendation is to go ahead and remove it (#3 - left parietal craniotomoy with biopsy and resection of tumor) with a biopsy first during surgery to check the tumor's nature, then remove it.
Actual surgery would be through a microscope, after the biopsy, the surgeons would use the results to determine more surgical solutions on the spot.
There would be an MRI in the operating room so it could be checked that all was removed before incision closed.
During surgery, Dr. Martin would be present as well as an anestegiologist, chief resident, MRI techs and nurses.

Should get surgery within a month


Questions:

How risky is spot? Not in the most delicate area, and there hasn't been much change in size.
There is a 5-10% risk of some neurological trouble that could effect reading, writing, memory, speech, paralysis of weakness on right side of body.


Would the surgery be performed by a student, or specifically you? The preparation work for surgery (stabilization, incisions, closures, etc.) would
be performed by supervised medical interns, but the actual delicate surgery would be performed by Dr. Martin.

Is the tumor getting bigger or smaller? Doesn't seem to be much change in size in the past month.


Can tumors be caused by parasites (i.e. sushi)? There is no proof of this.


Had Epstein bar at one time, could it be related? Nothing to prove that this is related.

I read that Dialintin interrupts vitamin d metabolism, and could soften bones, should we be concerned? This is an unusual side effect, but should be sure to take vitamin supplements.

Explain elevated ALT/AST? This is common because of the use of the anti-seizure drug. The current levels are expected, but we should be sure
to keep an eye on these levels and get blood test in a month to check again.


What kind of treatment after tumor removed?
Continue with dialantin? You shouldn't abruptly stop, he would stay on dilantin for several months
If biopsy confirms tumor, radiation would be required, possibly chemo with medicaction
Hospital stay - 5 days
Recovery - 8 weeks

What's next:
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11/1 @ 11am Meeting with Dr. Kim (Neurosurgeon #2) to review 2nd MRI and functional MRI
11/8 @ 3pm Dr. Shelka - Pulminologist to discuss findings in lung from CT scan
- UCLA will be sending our first chest xray films back to us through the mail
- after pulminologist says "all clear" possibly schedule surgery for late Nov. or mid Dec.
- Mark will donate blood for himself 2 times before surgery
- blood test to check dilantin and ASL/AST levels