Expert: Claes-Gustaf Nordquist, M.D. - 5/16/2011

Question
After being rear-ended by a drunk driver doing 65 in a 35-mph zone that caused cartilage injuries to my neck and c1-atlas junction almost 20 years ago; I have been suffering with a constant headaches that just kept getting progressively worse. Every time I saw my regular doctor and told her my symptoms she would keep telling me it was a "tension headache" or "It's just joint pain" during my last bout of severe head pain, nausea, vomiting; I started having a loss of coordination, slurred speech and then the whole right side of my body went numb. Thinking I had a stroke I went to the ER and they did a CAT, but said it was normal and that the problem was probably my neck, I saw my regular doctor and she just put me on Gabapentin, more pain killers and Sulindac. I HATE the side effects of pain killers, which I feel only treat the symptoms so I found (referred myself)a neurosurgeon who was willing to see me and do an MRI of my neck, when they did the MRI they got the lower part of my brain and found the tumor. I got 3 "second opinions" and all of the neurosurgeons say the tumor is 1.9mm x 1.6mm and needs to come out because it is putting pressure on my brain stem, my c1-atlas needs to be fused as well and they will 'fix it' when they take the tumor out. PLEASE, How can such a 'small' tumor cause so much pain and discomfort and how long will I be in the hospital? because None of the surgeons I have seen can give me a straight answer. Nor can I find very much post surgery information on the web detailing what to expect after my surgery. Any information you can provide will be greatly appreciated.

Answer
First of all I'm not a neurosurgeon but a medical oncologist & radiation therapist with experience of treating brain tumors. But since I'm not a neurosurgeon questions with regards to surgical problems should be directed to an expert of neurosurgery. That tumor - if its size information is correct - is quite small and I doubt that it can cause that much pressure. I think it has been discovered on your MRI scan just by coincidence. However it should be taken care of. It is small enough to be deleted radiologically without any surgery at all by the use of the so called GammaKnife if that is your choice. However a biopsy (can probably be done stereotactically as a needle biopsy via a small hole in your skull based on MRI scans) is most probably needed to have a clear diagnosis. Probably the other neurosurgical operation is indeed needed! Without a clear diagnosis of your tumor I can not give you any prognosis opinion. Your own doctors are in the same position. Good luck! By the way does your lesion disturb the flow of your cerebro-spinal fluid? If it does your situation is even more serious and urgent action is needed!

Thanks! I agree that something needs to be done and SOON! but it can probably just as well be done with the GammaKnife as with surgery though a biopsy IS needed! A neurosurgeon has then a point in saying that surgery will take care of that need too! And that is correct. But if I happened to be the patient I would want a biopsy and after that GammaKnife treatment. But the choice is of course yours!




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