Monday, November 05, 2007

The Incision

Stock photo of a brain. The grayish brown portion is the cerebellum. The brainstem is the small portion you see sticking out underneath the cerebellum. The large tumor (vestibular schwannoma) was compressing the brainstem (lodged between the brainstem and cerebullum) while the other tumor (meningioma) was abutted up against the larger one.
Relative size of the tumors: vestibular schwannoma - 3.4 cm
meningioma - 2.5 or 2.8 cm



Photo taken October 4th, 2007 (first week home after surgery). Click the lighthouse link in the post title above to see a diagram of this surgical procedure: Subocciptial Craniectomy via Retrosigmoid Approach Here is a picture of the incision so you can see how large of an area they had to drill in order to reach the tumors. The incision is in the shape of a C behind my ear. From what Harley told me, it had to be this large so they could lift my cerebellum (the back part of the brain) in order to access the 2 tumors near my brainstem.

Originally my mom told me the stitches were brown. I later came to learn that the dried blood on my scalp made them appear that way when in fact they were translucent white like fishing line. Two and a half weeks after surgery Harley had picked a couple of these pieces off that were sticking out of my head. The stitches are dissolvable so they sloughed right off.

The surgeon's report of the procedure is absolutely amazing! It is very technical however, so I will provide a description in layman's terms.
First I was placed in a position known as "prone" which is face down like getting a massage. For this procedure I was arranged at "three quarters prone" (which means I was partially upward and not lying completely flat on my stomach). After removing the bone and lifting the cerebellum, a microscope was inserted underneath that identified the first tumor which was gray in color. Biopsies confirmed it to be a meningioma. An instrument called a Cavitron was used to debulk and remove this tumor. Then a yellowish tumor next to it was identified as the vestibular schwannoma. The surgeon carefully dissected this tumor on its edges and identified the 9th, 10th, and 11th cranial nerves. Then he continued to dissect it by debulking it from the center and carefully dissecting it from the cerebella portion of the brain and brainstem. Also, the compression of the tumor on the trigeminal nerve had caused my symptoms of trigeminal neuralgia prior to the surgery. Thus, this area was also dissected and decompressed (pressure relieved through removal). The part of the tumor which had grown into the IAC: inter auditory canal was also removed.

Facial nerve electrodes had been placed on my face to stimulate and monitor the facial nerve. Seeing as I had experienced facial weakness from the previous radiosurgery to this tumor, the small portion of tumor around the facial nerve was left to prevent further damage.

Closing me up
The mastoid air cells were waxed, and titanium mesh and Norian bone cement used to seal the opening. Once the cement hardened, the temporalis muscle and scalp were put back in place and the incision sewn shut.

Update
It is pretty healed by now. I have been wearing a baseball hat without a problem for a few weeks now while taking my walks. It has been itchy and I have tried not to scratch in but I think I might have in my sleep. I am pretty certain it is all healed and that next week maybe I can get a long over due haircut (trim) and hopefully dye it sometime soon. In another week I believe I will be able to return to water aerobics, go in the hot tub, and take a bath. The concern prior of doing those activities was exposure to infection.

An interesting thing to note -
The area between my ear and the incision is numb but the incision area itself is sensitive to touch.
On the area of my neck extending below my ear, I feel some bumps. This would be scar tissue that I am wondering if it will go away in time. It is a little irritating as at first touch I forget what it is and want to itch it off like some kind of bug bite or zit.

1 comment:

kw said...

This is laymen's terms? :-) I think I need Antomy 101 to understand what was done to you, but glad the incision is healing. I bet that hair cut will feel great!

Kim