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Straight to the point ….

April 15, 2008

My manager called this morning to hear how I was doing. He is flying all over the place, I hope he takes care of himself but I know he doesn’t. I briefed him on my situation and I’m always surprised about the type of questions he asks me and I appreciate his genuine interest in my situation. He was on his way to Reading andhe gave me a business update. We had not been in touch for a while but as we’re bothbusy with completely different things I’m not surprised. Thanks for your call Bas, I’m looking forward to seeing you soon.

This afternoon I had an appointment with my Neurosurgeon. I thought it would be the last one before surgery but I now understand that the team of Neurosurgeons will visit me on Wednesday afternoon. More about that later. I went to the appointment with my mother as Monling had to stay in bed with a fever/cold. That gave us the opportunity to introduce my mother to Super Nurse and to have, as agreed in the family, the order of the contact persons changed (mother-wife-me instead of me-wife-mother). I will make a communication plan for family, friends and colleagues that hopefully is pragmatic enough to work.

The Neurosurgeon came straight to the point and presented changes in the surgery approach based on the recent large and minor seizures and the Edema. He explained that he was not very surprised that my right hand now joined the party (frequently, see my week reports) as the functional areas for hand and leg are just centimeters apart in a healthy brain. In my case they have been pushed apart by the tumor (in the left hemisphere) but the relative distance is still comparable.

He spoke about the complete removal of the SMA (Supplementary Motor Area) that lies in the medial part of area 6 and is responsible (I believe) for the planning (initiation) of complex movement and the coordination involving both hands. Here you can find a link to an extremely clear website explaining the various motor functions (by Canadian Institutes of Health Research). I know that failing functions on one side of the brain (in my case the left side) can be ‘rebuilt’ by the half of the brain. He predicted a period of 3 months for that process to take place.

We spoke again at length about the removal of the tumor in the speech area. I have the feeling that he is not completely sure what to expect in this area. So the following is my analysis and not by the Neurosurgeon.

At certain MRI slices (photos) of my head the tumor seems detached from the main tumor but I’ve been told it is just one tumor. It is easy to see the parts connect at other MRI slices. Language and speech are very complex functional areas. I don’t know exactly how the position of the tumor is related to Broca’s area and Wernicke’s area but I’m pretty sure that it may be in or near to Broca’s area. These areas are connected by a ‘tunnel’ of fibers, the language loop. Moving from Wernicke’s area to the Broca’s area you can find the following functions:

  • Seeing words passively
  • Listening to words
  • Pronouncing words
  • Generating words

When looking at the MRI images do I think that my tumor is close to the latter two functions. I base all this on information I found at another link from the same website (Canadian Institutes of Health Research) dedicated to language and speech.

The Neurosurgeon gave us more information about the Surgery Duration (please refer to my post “Surgery Planning” of the 8th of April). This is the plan:

  • 07:30-08:00  I will be taken to the operating theatre
  • 08:00-08:30  I will be given a general anaesthetic
  • 08:30-09:30  Equipment will be installed (neuro-navigation, etc.)
  • 09:30-10:30  The access to my brain will be made
  • 10:30-13:30  Measurements will be performed
  • 13:30-15:00  Actual surgery (tumor will be removed)
  • 15:00-16:30  The access to my brain will be closed
  • 16:30-17:00  I will be taken to High Care

My family will be called by the Neurosurgeons and have to go to the hospital. They will be briefed about the outcome of the surgery while I’m in High Care.

Then about probabilities: there is a 5% chance that I will have a permanent loss of motor function(s). The Neurosurgeon expects that this will not be my first and last brain surgery. Further treatment will depend on the result of the biopsy.

Radiotherapy will be required if the tumor has become a grade 3. The tumor has become more clear since the 2nd seizure. The Neurosurgeon does not consider a grade 4 and also does not believe that the tumor is a standard (“bad”) grade 3. He believes that it will at most be a “good” grade 3. Further treatment will in that case be Radiotherapy. We’ll cross that bridge when we get there.

By the way: in 15% of cases the hospital is unable to determine correctly (either way) from the photos what they later find during surgery. Only a biopsy of a large enough part of the tumor will tell for sure what grade tumor it is.

Maybe you have seen the short film introducing the Awake Craniotomy of a young woman (please refer to my post “D-Day Surgery 24 April 2008”. I asked if I could have a similar presentation by the Neurosurgeons. He seemed delighted to do so. So next week Wednesday (after having been admitted to the hospital) I will meet both Neurosurgeons and they will explain my situation in vivid colours. I’m looking forward to that!

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