Neurosurgeon #3

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We met with:

Dr. Keith Black
Nurse: Precious
Neurosurgeon @ Cedar Sinai Hospital, Los Angeles, CA
10/19/05


Here's the results of our conversations:
Can't give a definitive diagnosis based on MRI only. Possibilities could be a tumor that originates in brain or elsewhere, could be infectious process or inflamitory process. Could even be a parasite from eating sushi! (we love sushi, I hope this isn't it!) Options are to wait a bit and do a repeat MRI scan, if getting smaller might not be tumor, if it is getting bigger probably is a tumor. Another option is to do something now like a biopsy. A biopsy is possible with a needle, but it looks like there is a vessel over the tumor and it might not be a good idea to use a needle because it could cause bleeding. Better to make a bigger opening and get a better look to get a piece, less risk. They have microscopes with cameras and computer driven to help do this kind of biopsy. The CT scan looked clear which indicates there is not a primary tumor in the core. This MRI scan is tough to determine specifically what it is and we will need to know more before determining treatment. Probability of metastatic tumor is low, because of Mark's age group and low common factors for cause. Probably should repeat MRI scan to check size and then get a piece of it. Light excersize is OK as long as it isn't heavy lifting since it could cause irritation on that vessel near the tumor.

Questions:
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Can tumors be caused by stress? no

Can it possibly go away? If it is infection or inflammatory it could possibly go away unless it is infection from bacteria.

Why is it swelling? Irritation

Would the swelled tissue need removed too? no

What are the signs of a metastatic lesion vs. primary tumor?
- is it true that 3/4 of brain tumors are metastatic? Yes, but doesn't mean anything in this case.

What is involved in a biopsy? Patient is awake, make a small incision in scalp, pinhole in skull so they can
see with microscope and computer to avoid any vessels and get a piece of it.

Do certain neurosurgeons specialize in certain types of tumors? Yes, some specialize in pituitary, some in other specific kinds but many are multi-tumor specialists and can deal with several kinds of tumors.

What are the risks based on its location? Probably sitting in area that controls sensation of right side of the body. Close to language, motor areas. Low risk of stroke, infection, bleeding.

What's next:
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second meeting with Dr. Kim (neurosurgeon #2) 10/24/05
second meeting with Dr. Martin (neurosurgeon #3) 10/28/05
second MRI scan in a week or so