The eloquent brain

As a diligent student of melanoma, I would never have thought it possible to be blindsided as I was by what happened this week. I was nearly dead wrong about several things.

To recap, I was taken by ambulance the 90 miles from Corvallis to Providence Medical Center on Saturday after an emergency head CT scan revealed a large tumor (melanoma metastasis) that was bleeding in my right temporal lobe. I’d gone to the ER because of an unrelenting headache and vomiting that had finally convinced me that what ailed me was something more than the flu and/or an ear infection, for which I’d seen my GP a day earlier.

Once I was admitted at Providence, an MRI scan was ordered and I was put on steroids and pain meds. The apparent severity of my symptoms left no doubt in the minds of the neurosurgeons that I needed immediate surgery; the time for conservative treatment had passed. A surgical team was assembled that evening, and the five-hour procedure began the next morning at about 9.

For brain surgery, this one didn’t have a lot of subtleties. The 3x4-cm mass was positioned just beneath  the skull and, typical for melanoma, was very dark and easily demarcated from normal brain. It was easy to see what needed to be removed.  The team did a craniotomy wider than was technically required so the brain had extra space into which to expand, thus helping to relieve intracranial pressure.  Without decompression, I might not have survived the next 24 hours.

I was informed of the risk to my peripheral vision caused by the location of the tumor, and the possibility of stroke. The surgeon also discovered once he was inside that the tumor was wrapped around a major vein, making it highly vascularized, and attached to the dura mater. There were pockets of blood between the lesion and brain, which is normally not a good sign, but in this case they helped the surgeon by minimizing disturbance to the brain tissue itself.

As of this morning, I’ve noticed no damage to the so-called eloquent brain—those areas that allow us to communicate, perceive, interact, move, talk and regulate our senses. My surgeon deserves enormous credit for his technical skills, but I also have to admit I’ve been lucky. Had the tumor been in the left temporal lobe, in exactly the same position as mine was on the right, I could easily have suffered substantial loss of vision and cognition.

And so I’m on the mend, dizzy most of the time and deeply fatigued, but with only minor headache pain. The steroids are slowly bringing my brain back down in size and reestablishing a midline that puts intracranial pressure back to normal. I have reason to believe that my brain will function normally within a few weeks and that I’ll be able to drive (and run!) again.

Until then, I have crucial decisions to make about adjuvant radiation (of the brain) and whole-body drug treatment. Now that the melanoma has advanced beyond just subcutaneous mets, almost anything is possible in terms of recurrence. It’s also possible that I may have many months of NED, as my world-class immune system continues to do its thing.

I’ll explore in a post later how casual I was to the monitoring of my disease progression. In my defense, I'll say that when I finally did have a PET/CT scan on Aug. 1 it showed nothing abnormal in the brain (and very little else in the body). I had figured all along that should mel reoccur, it would almost certainly be in the visceral organs; I was ready for that. The brain was simply not in play. The corruption of this crown jewel of the human body was too hard to imagine. Yet this is exactly how things turned out, so now we'll deal with it.