Just to recap, within a couple of days of me collapsing in February, Worc Royal had carried out a CT scan of my brain. This showed what they thought was an aggressive brain tumour. This was followed by an MRI scan the day after and because Worcestershire has no brain tumour experts, this and the CT scan were sent to the Walsgrave Hospital in Coventry for analysis and subsequent diagnosis.
I waited nearly 2 weeks for a bed at the Walsgrave but within hours of arriving they carried out more scans, of both types and I was placed in the care of a Neurosurgeon - an internationally renowned one at that. This was not so that surgery could be done to remove the tumour but so that a biopsy could be performed - it had already been established that this tumour was inoperable as it was in the very centre of my brain. The biopsy was to confirm the presence of a tumour and to determine precisely the type of tumour cells present so that the appropriate treatment could be provided.
As soon as the results of the first CT scan were known, Worc Royal had started me on a high dose steroid (Dexamethasone) and an anti-convulsant (Phenytoin). This was to prove a double-edged sword but no doubt saved my life. The scans taken at the Walsgrave showed that the mass lesion had reduced dramatically. We saw both sets of scans the night before my biopsy (29th Feb) when the Neurosurgeon explained that this often occurs when Dexamethasone is administered. What was shocking was the Worc Royal scans showed a huge volume of my brain taken over by a mass lesion - I was sort of grateful that it had diminished so much!
That same evening (about 8pm actually) my Neurosurgeon explained the biopsy procedure again to both of us (his registrar had already delivered the details earlier to both of us - via phone to Jane). It was to be done using image guided neuronavigation with the surgeon using markers (fiducials) on my head and the scan images to help guide the biopsy needle to the right area within the brain. Jane kept telling me I should be grateful to the physicists (but then she would!) and I maintained it was the engineers who turned the theory into the practicalities!
The biopsy on Feb 29th returned 4 good samples but later these were to prove to 'just be' samples containing only normal brain cells - no tumour cells. The surgeon checked again that the biopsy was taken in the correct area of the brain - and it was. The Dexamethasone had reduced the tumour so much that tumour cells were difficult to obtain.
Diagnosis could only be made based on radiology alone. The lesion was surmised to be a Lymphoma due to its behavioural response to the Dexamethasone. However the Haematologist was not convinced - apparently other brain degenerative diseases can behave in the same way in response to steroids. He wanted histology to confirm exactly what he was dealing with before he would consider next steps for treatment.
There are serious risks associated with a brain biopsy (infection, bleeding, stroke, fits and death) and roughly 1 in 100 patients have complications and probably due to these my Neurosurgeon was unwilling to perform the biopsy more than once even though he was being 'coerced' by the Haematologist! In the end my Neurosurgeon 'won'. As he put it, if he did the same again it was very likely it would result in the same outcome. If he went in deeper there was a higher risk of hitting the brain stem, and that would be 'curtains'!
I understood that term!!
....to be continued.