I recently had an appointment with a local neurosurgeon who consulted with a doctor that specializes in the management of problems involving the cerebral vasculature. They discussed the safety of leaving the mesh in my head as the local neurosurgeon believes that "there is potential for the titanium to involve the wall of the vessel [carotid artery]." His concern is the close proximity of the mesh to the pulsation of the artery. He asked the vascular neurosurgeon if there was any benefit of obtaining an arteriogram to determine the safety of the situation and he doesn't think there is. Both doctors agree that removing the titanium mesh would be difficult and that an attempt to do so would carry a risk of injuring the left carotid artery...they don't recommend it. He referred me back to Dr. Kelly for his opinion on this.
I followed-up with my local ENT in December to discuss the recent consults and there are a couple things on the table to consider right now. It has been made clear to me by all of my doctors in Dallas that they will not remove the mesh from the sinus because they lack the experience and feel it is too dangerous. It is not clear as to whether or not the mesh is the source of infections in the sphenoid so concerning this I have three options:
1. Continue taking medications when the symptoms arise and just keep watching the area via CT scan.
2. My ENT has suggested he go in and open the sphenoid, culture, and photograph the area to confirm (or rule out) any problems. This will aerate the sinus and allow him to have a visual as to where exactly the mesh is sitting inside the sphenoid without touching it and determine what (if any) bacteria is causing the problem.
3. Return to my neurosurgeon in California and have the mesh partially removed. I have spoken to Dr. Kelly and he is confident it can be removed safely as he has done this to several other patients in the past. He wants me to consult with his ENT, which I have agreed to do. One problem though...neither doctor takes my insurance. My neurosurgeon moved to Saint John's Heath Center and dropped off my plan about a month after my surgery at UCLA was canceled (in 2007). I am currently petitioning my insurance carrier to approve treatment since my doctor was, at one time, contracted with them. I'm not sure how this will fly, but it doesn't hurt to ask.
I have been mulling over the decision of whether or not I should go back to Dr. Kelly for surgery this year. Depending on what my insurance comes back with will determine how aggressively I plan (if I can plan at all...) a trip to California. Until something can be worked out my ENT said he will help treat the infections. If my insurance denies my request for coverage then I may have sinus surgery locally and just go from there.
