Planning for the Gamma Knife Procedure

Today Steve and Terry had appointments to prepare for the next step in dealing with this new tumor.

First, they met with Dr. Patil who was the neurosurgeon who removed Steve's big tumor just over two years ago. He coordinates Steve's care at Cedars-Sinai. He will be the one this time to place the halo on Steve's head with screws to the skull which prevents Steve's head from moving for the precision work of the radiation beams.

Then they met with the radiation oncologist, Dr. Hakimian.  They had met him before when Steve had radiation therapy and he directed Steve's previous radiation treatment, coordinating with the closer facility to home. This time, radiation will only last one session so it will occur at the Cedars facility. Dr. Hakimian had a Resident, Dr. Resnick who talked to them about what to expect.  He also said he had to look at Steve's MRI several times to find the tumor since it is so tiny. (Yay! tiny!). Steve's neurological exam came out perfectly fine. He has no deficits from this tumor. He doesn't have any vision problems and drives and reads the same as always.

 After the appointments, they felt better about the future. Every doctor was optimistic. They felt reassured by how often they heard "very small" or "tiny" or the gamma knife "should do the job" to stop the tumor. They liked their doctors and staff and they said the day was as pleasant as it could have been.

The plan will go something like this:

Prior to the procedure, Steve will start taking steroids to control swelling.

It will probably be on April 11th, a Friday, pending pre-authorization from the insurance company.

They will go to Cedars at 6:30 am and plan to stay until 2:00 pm.

First, Dr. Patil will attach the halo.

Then, Steve will be taken for an MRI with contrast and they will map the brain and make the final decisions on the radiation settings.

Steve will receive radiation from 201 sources (where did that number come from?) targeting the tumor site in the splenium. The gamma knife procedure will take between 15 minutes to 2 hours, but will likely  be on the shorter side since this new tumor is so small. The total radiation dose is expected to be larger than he received last time.

They remove the halo and Steve can go home.

Probable side effects are only headache lasting several days and that is from the pressure of the halo, not the actual radiation dose. There is a 5% chance of necrosis but steroids help prevent that (I'm not clear here about what is necrosing. Necrosis is a fancy word for dead tissue and I thought the tumor is supposed to necrose or die. Maybe this 5% chance is for surrounding healthy tissue dying? I guess we'll find out later if it becomes a problem.)  He is planning to be back at work on Monday.

In the meantime, tonight Steve takes his last of 5 chemotherapy pills for this round. So far, he is not feeling sick. Terry says his mood is good and all is as well as can be expected. The worst part is dealing with the insurance company and the pharmacy. Last Friday, Terry spent hours on the phone getting Steve's chemo pills shipped overnight. The company was going to take 5-8 days to process the order before shipping them. Ugh! Terry's really good at dealing with that. Tomorrow she plans to call the insurance company to expedite the pre-authrization process for the gamma knife procedure.  Way to go, Terry!