Supraorbital Bone Tumor

[Rob2008]

Hello, thanks for taking my question. First I want to say that I see a neurosurgeon at a major hospital every year for this, and that I will always take his advice over any internet advice, But I wish that you could weigh in on your thoughts for me, "just for fun"

I'm a 30 yr old average suburban white male, please allow me to describe my symptoms..
About 5 yrs. ago I started having a vague, mild head pressure, and some constant dry nasal swelling.  Then in mid 2005, the headache became far worse.  The headache is always constant, and has only slight variations.  It is a dull pressure that doesn't get worse with exercise and it's there 24/7, it never goes away.  It's location is rather diffuse but it's deep in the center and behind my forehead.  It feels dull, like the inside of my head is "asleep", like your foot would fall asleep. My forehead feels stiff, and head feels very heavy.
I also get frequent throbbing headaches like a migraine "two types of headaches at once" is what I say.   The throbbing headaches respond well to NSAID's but the head pressure has responded to nothing, i mean I have tried everything you can prescribe.
Recently, I have began to feel very faint or lightheaded alot, and have had brief spells of extreme confusion (where I don't know what's going on for 5-10 seconds).  I had a good cardiac workup that was negative as well.

Originally, there was some debate of the actual cause of my symptoms, however now there seems to be acknowledgement that my tumor is probably causing this since I have had a bad headache for 3 years now, since no one can find any other cause. There is also debate about what it is, I have heard "fibrous dysplasia"  "meningioma"  and yet another "it could be several things".   The good news is it has not grown at all in 3 years and it's about 3.5x2.5 cm.

Can you please look at these images and give me your thoughts?
I've prepared (it's a simple and safe webpage):

http://robsaysrelax.googlepages.com/home

[Michael Lim, MD]

Unfortunately, it is difficult for me to make a diagnosis based on radiology alone.  In general, some tumors can cause seizures.  I realize that you don't have insurance, but the answers to your question are not straightforward and cannot be solved though this interaction alone.  It would be best addressed with your treating doctors.  

[Rob2008]

Dr Lim,   Since you mentioned it, I did in fact have a radionuclide full body bone scan and a SPECT of the skull.    There was intense focal uptake of the tracer at the lesion but nowhere else in my body.    

Again, I know none of this is formal,   but given the rest of my MRI is normal,  this tumor is 3.5x2.5 cm,   and based on what you see,   can you please tell me what is your best guess as to what this tumor is,    and if it would be consistant  with a nonstop dull headache.      

Also,  what do you believe about the derealization I experience on a constant basis,  and "brief attacks of confusion"....Could this be seizures or some effect of the brain compression in this prefrontal cortex area?

Again, thank you for you time -  Your opinoin matters greatly as I have no insurance.

[Michael Lim, MD]

I agree with your first statement completely in that seeing your neurosurgeon should not be replaced by our online information page.  In general, sometimes benign growths can cause headaches.  Especially if the growths are causing mass effect.  However, coming to that conclusion can be quite complex as you probably can tell and I wouldn't be able to tell you if I think that your growth is the cause of your headaches from our blog.  

While you have a nice organized set of pictures on your website, I also cannot render an opinion on what I think the lesion is without seeing all of your films. In terms of the tumors mentioned, meningiomas are usually benign tumors and if completely resected, can often result in a cure.  Fibrous Dysplasia can be a more complex disease.  Bone is replaced with fibrous tissue.  Often times, patients will have multiple areas of fibrous dysplasia.  Often times, people will get their other bones scanned to assess for other lesions.  Sometimes headaches can be a symptom for both.

[Rob2008]

PS - I have had 3 dilated eye exams, and visual field testing - All normal 100%