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Neurology (Expert Forum)
Another craniotomy?
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Another craniotomy?
by gd__0, Dec 20, 1998 12:00AM
You have answered some questions for me in the past few months and I am still working on the same problem. After having my first seizure, which prompted an MRI, a large mass was found in my left temporal lobe. The neurosurgeon diagnosed this as a low grade glioma and performed a craniotomy. The plan was to confirm diagnosis and remove the "core" of the tumor. During the surgery, the immediate biopsy came back normal. The surgeon said he could not "see a tumor". The MRI done 2 months later still showed a large mass. The doctor doing the MRI report stated that the biopsy samples had missed the mass (explaining why they came back normal). The neurosurgeon does not believe he could have missed the tumor (4x4x5cm). Something I don't understand...When you are performing a craniotomy, how big of an area can you actually see? Can you physically tell the difference between a tumor and normal brain tissue with just your normal eyesight?
I have gone to a second opinion who thinks it is very important to get this diagnosed. His suggestion is to have a needle biopsy. If it is a glioma, do another craniotomy to remove as much as possible. If the biopsy were to come back again as normal (I think he does not expect this), then he would still suggest a cranitomy to get a more accurate biopsy. If the craniotomy is the plan either way, why go through the needle biopsy? This is very difficult to decide since I had a craniotomy 3 months ago for basically the same reason. I don't know if the first surgeon made an error in the location or the second surgery would produce the same results. What would you do if it was your head?
Thank you very much for any input. I find this forum extremely helpful.
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Dear GGD,
If the surgeon's plan is to remove the tumor in either event, it makes no sense to perform the needle biopsy as an initial procedure. It is difficult to render an opinion on what this may be without seeing the MRI's that have been done. Regardless, if the mass is in an accessible location surgery may be a good option.
If this is indeed a low grade glioma that is not causing problems, a simple biopsy may be all that is necessary. Whether a low grade glioma should be resected has been argued both ways in the literature. Some say it may become an aggressive tumor if given time, arguing for surgery. Others say that the tumor may become aggressive whether or not surgery was done. The jury is still out.
In any event, to do the biopsy and plan a resection at another time regardless of the findings doesn't add up. Speak to your surgeon about his goals in your situation for further clarification.
Incidentally, one can often determine whether brain tissue is abnormal just by the appearance, though this is not always so.
Good luck.
