Here's what we discussed:
Regarding the tumor: He agrees with the recent MRI report that the tumor is stable and has not grown since last year. Depending on how it's measured, it's possible one doctor might perceive the tumor has grown, but overall he thinks it is unchanged. However, even though the tumor is stable he recommends gamma knife radiation. The tumor is small and so the the amount of radiation needed is minimal. In the long run a little bit of radiation could spare the surrounding structures of damage (specifically the optic chiasm) and stop tumor growth before it gets too big (and requires a larger amount of radiation). There is no question as to whether or not tumor exists in the left cavernous sinus, now the concern is when to start radiation...he suspects the tumor will continue to grow in the years to come without it. He suggested I discuss this with Dr. Kelly and my endocrinologist at M.D. Anderson. However, both doctors are aware of the residual tumor and neither one recommended radiation at this time, so I will not revisit this right now.
Regarding the titanium mesh: The doctor showed me where the mesh is located in my head. This is not easily identified on my previous MRIs, but clearly detailed on my most recent CT scan. For the past few years I have been under the impression that the mesh was wedged in the sphenoid sinus and not in close proximity to my artery. The most recent report states that the mesh is located along the mid and posterior sphenoid sinus, but also slightly extended upward into the left cavernous sinus and near the left artery. The mesh is encapsulated with bone and so removing it would be quite a dangerous task. He thinks carotid artery injury is likely during an operation and so it is strongly recommended that it be left alone. He is going to consult with a vascular surgeon regarding the placement of the mesh and whether or not any additional tests could be done to enlighten him to as to what risk (if any) there is to leaving it in my head.
Regarding the sphenoid sinus: What can be done to treat ongoing infections? The neurosurgeon thinks that surgery to open the right side of the sphenoid would engender air circulation and enable drainage. He mentioned this could be done by my ENT without going near the mesh. He's not sure what the cause of chronic inflammation or infection is, but he thinks this is a possible treatment plan.
The situation is not dire and the doctor is going to get back with me in a week or two with more of his thoughts after he's had a chance to discuss the findings with the vascular surgeon...I'll update then.
The situation is not dire and the doctor is going to get back with me in a week or two with more of his thoughts after he's had a chance to discuss the findings with the vascular surgeon...I'll update then.
