#Meningioma Surgery

[hmsdesk]

(via Meningioma Surgery Cost in India)

[kondavanelos]

Μηνιγγίωμα εγκεφάλου.

[medical-23]

Illuminating the Path: Innovations in Meningioma Treatment

Meningiomas, the most common primary brain tumors, require careful consideration and personalized treatment approaches. These tumors arise from the meninges, the protective membranes surrounding the brain and spinal cord. The landscape of meningioma treatment has undergone remarkable advancements, providing hope and improved outcomes for affected individuals. This creative article explores the intricacies of meningioma treatment, delving into innovative surgical techniques, targeted radiation therapy, emerging molecular therapies, and the importance of multidisciplinary care. By illuminating the path of meningioma treatment, we strive to empower patients and healthcare professionals alike.

Understanding Meningiomas

Meningiomas are tumors that develop in the meninges, predominantly affecting the outer layer of the brain. While most meningiomas are benign, some can be aggressive and exhibit malignant behavior. These tumors can cause a variety of symptoms depending on their location and size, including headaches, seizures, vision problems, and neurological deficits.

Surgical Innovations: Maximizing Resection and Minimizing Risk

Surgery is often the primary treatment for meningiomas, with the goal of achieving maximum tumor resection while minimizing the risk of complications. Innovative surgical techniques, such as skull base approaches, neuroendoscopy, and intraoperative imaging, have revolutionized meningioma surgery. These advancements enable surgeons to access and remove tumors in challenging locations while preserving critical brain structures and minimizing the risk of postoperative complications.

Targeted Radiation Therapy: Precision and Efficacy

Radiation therapy plays a crucial role in meningioma treatment, particularly for tumors that cannot be completely resected or are recurrent. Recent advancements in radiation therapy techniques, such as stereotactic radiosurgery (SRS) and proton therapy, have significantly improved treatment outcomes. These modalities deliver precise and targeted radiation to the tumor while sparing surrounding healthy tissue, reducing the risk of side effects and promoting tumor control.

Molecular Therapies: Unlocking New Possibilities

Emerging molecular therapies are reshaping the landscape of meningioma treatment. Through the identification of specific genetic mutations and molecular pathways, targeted therapies, such as receptor tyrosine kinase inhibitors and hormone-based therapies, are being explored to disrupt tumor growth and improve patient outcomes. Clinical trials and ongoing research aim to uncover novel therapeutic targets and advance personalized treatment options for meningiomas.

Multidisciplinary Care: A Collaborative Approach

The management of meningiomas necessitates a multidisciplinary approach, involving a team of neurosurgeons, radiation oncologists, medical oncologists, pathologists, and other specialists. Collaborative tumor boards, where experts from different disciplines discuss individual cases, ensure comprehensive treatment planning and personalized care. This multidisciplinary approach facilitates optimal decision-making, tailoring treatment strategies to each patient's unique circumstances.

Rehabilitation and Supportive Care

Meningioma treatment extends beyond medical interventions. Rehabilitation therapies, including physical therapy, occupational therapy, and speech therapy, are essential for individuals to regain functional abilities and improve their quality of life. Supportive care, including psychological support and symptom management, helps patients cope with the emotional and physical challenges associated with meningioma treatment.

Promising Future Directions

The future of meningioma treatment holds promising prospects. Advancements in genomic profiling and molecular characterization of tumors will enable targeted therapies to become more precise and effective. Immunotherapies and novel drug combinations are also being explored to enhance treatment outcomes. Additionally, ongoing research aims to identify biomarkers that predict tumor behavior and response to treatment, further guiding personalized therapeutic approaches.

Conclusion

Meningioma treatment has witnessed significant advancements, providing patients with renewed hope and improved outcomes. Innovative surgical techniques, targeted radiation therapy, emerging molecular therapies, and multidisciplinary care are transforming the landscape of meningioma treatment. By staying at the forefront of medical innovation, researchers and healthcare professionals strive to improve patient outcomes, reduce side effects, and enhance quality of life. With continued research, collaboration, and patient-centered care, the path to overcoming meningiomas becomes increasingly illuminated.

[brightmoontrigon]

deer of 9 colors 🌙🌈

hello friends! my recovery from meningioma surgery has been coming along, albeit with both its ups (partial improvement in my eyesight, feeling strong enough to get around mostly at my normal level) and downs (diabetes insipidus, sinus congestion, weird episodes of joint pain, and having some ongoing visual field impairment). still, I'm very thankful for the good things. I'm trying to make a little art again and wanted to invoke this auspicious creature for some luck and benevolence <3

[jcsmicasereports]

Primary dural-based parafalcine diffuse large b-cell lymphoma mimicking meningioma by Amr El Mohamad in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Primary dural-based diffuse large B-cell lymphoma is very rare. Only few cases were reported in the literature. Case presentation: Herein, we present a case of an immunocompetent patient with primary dural-based diffuse large B-cell lymphomas mimicking meningioma associated with ghost tumor phenomenon without any evidence of a systemic lymphoma. Conclusion: Primary central nervous system lymphomas are rare. Clinicians should always consider this lesion as a differential diagnosis if radiological findings are not indicative of typical one meningiomas.

Key words: Dural-based tumor, diffuse large B-cell lymphoma, ghost tumor, MATRIX regimen, central nervous system.

Introduction

Primary central nervous system lymphomas (CNSLs) (PCNSLs) are rare and account for 2%–5% of all brain tumor cases, whereas secondary CNSLs are more common [1,2]. One study has shown that the most common intraparenchymal histological type is diffuse large B-cell lymphoma, as among 26 patients with PCNSL, 25 had diffuse large B-cell lymphoma [3]. Although primary dural-based lymphomas are rare, the most common area of involvement is the cerebral hemispheres. Most dural-based lymphomas are secondary and present as extra-nodal systemic diffuse large B-cell lymphomas. Primary dural-based lymphomas are usually histologically marginal-zone lymphomas, representing a group of lymphomas that have been historically classified together because they appear to arise from post-germinal center and marginal-zone B cells and share a similar immunophenotype, and few cases were reported to be diffuse large B lymphomas [4]. Here, we present a case of an immunocompetent patient with primary dural-based diffuse large B-cell lymphomas mimicking meningioma associated with ghost tumor phenomenon without any evidence of systemic disease.

Case Presentation

A 58-year-old male individual previously healthy and immunocompetent presented with headache, recurrent vomiting, and memory problems lasting for 3 days. No loss of consciousness, seizure, subjective weakness, or fever was observed. On physical examination, the patient’s Glasgow coma scale score was 15; his pupils were 3 mm in diameter, equal, and reactive; and the patient had nominal aphasia without motor and sensory deficit. He had normal cerebellar functions, and cranial nerve exams revealed no deficit. Head computed tomography (CT) (Fig. 1) showed a 2.2 × 3.8 cm (transverse × anteroposterior) iso-dense lesion with internal hypodensity in the left parasagittal frontal region extending to the right frontal region. Extensive perilesional edema was observed with effacement of the sulci and mass effect on bilateral frontal horns, associated with 3-mm midline shift. Head magnetic resonance imaging (MRI) showed an isointense parasagittal lesion on T1 and heterogeneous intense on T2, with redemonstration of perifocal edema (Fig. 2). Head T1-weighted imaging with contrast enhancement (Fig. 3) showed a large, left frontal, parafalcine, irregular-shaped mass located below the superior sagittal sinus level. It measured 4 × 3 × 3.3 cm in anteroposterior, mediolateral, and craniocaudal, respectively. It showed diffusion restriction (Fig. 4). There was central hyperintensity on T2-weighted imaging, without post-contrast enhancement area representing cyst formation. It exerts a mass effect characterized by effacement of the adjacent sulci, compression of the left lateral ventricle, and a 3-mm shift of the midline structures to the right side, and the impression of our neuroradiologist was atypical meningioma. Regarding extensive edema, dexamethasone was started at a dose of 4 mg, thrice a day, and the patient was planned for craniotomy and resection of the tumor. Initially, the patient was reluctant to undergo surgery; however, subsequently, the patient agreed to undergo surgery after approximately 10 days. During surgery, parasagittal craniotomy was performed; however, to our surprise, no definite mass lesion was found at the proposed site, in contrast to the findings described on imaging. The falx was thinned out and partly deficient. A biopsy sample was obtained from this abnormally appearing falx. Moreover, we obtained biopsy samples under neuronavigation guidance from abnormally appearing tissue, which was completely intra-axial, deep down in the lesion visualized on navigation. On postoperative day 1, MRI head with contrast enhancement (Fig. 5) showed that the previously seen lesion had a significant regression in size. Its right frontal extension and adjacent enhanced meningeal tail showed size reduction. Moreover, some regression in the perilesional vasogenic edema was observed. A significant regression in the previously described enhancement was noted at the left-side lentiform nucleus and external capsule. The MR spectroscopy study showed an increased choline/N-acetyl aspartate ratio and elevated lactate level within the lesion.

The histopathology results of the first brain biopsy samples (Figs.6–7) obtained from the falx cerebri showed meningothelial hyperplasia with calcification and focal perivascular lymphocytic infiltrate composed of small and large, atypical lymphocytes. Immunohistochemical staining was performed; however, the area of interest disappeared. The pathology team recommended another fresh biopsy to have the final diagnosis and flowmetry studies. So, the patient underwent redo craniotomy using the same incision, and multiple biopsy samples were taken. The second fresh brain biopsy (Figs. 8–9) showed multiple brain fragments with predominant perivascular atypical lymphoid infiltrates. Most cells were medium to large with moderate cytoplasm, atypical irregular nuclei having vesicular chromatin, variably prominent nucleoli, and several mitoses, including atypical one. Necrotic areas were also seen. Immunohistochemistry of the second biopsy (Fig.10 A-D) showed that atypical perivascular cells were positive for CD45, CD20, CD79a, BCl2, BCl6, MUM1, OCT2, and C-MYC, and negative for CD10, CD21, TDT, ALK1, EBV-LMP1, CD3, and CD5; however, few reactive/residual lymphocytes were positive for these enzymes. Moreover, 80% of lymphoid cellular nuclei were positive for Ki67. These findings were consistent with diffuse large B-cell lymphoma, not otherwise specified.

Whole-body positron emission tomography (PET) showed intense fluorodeoxyglucose (FDG) uptake higher than that in the healthy brain cortex, without evidence of coexisting systemic disease. In addition to PET scan, contrast-enhanced chest, abdomen, pelvis CT did not show any other lesions in the body; furthermore, workup for viral markers and autoimmune conditions were all unremarkable, thus confirming the diagnosis of “primary dural-based diffuse large B-cell lymphoma,” distinguishing it from secondary CNSL. The patient was transferred to the Oncology Department and started on three cycles of the methotrexate, cytarabine, thiotepa, and rituximab (MATRIX) protocol, which is the current standard treatment regimen for PCNSLs [5]. Three months after the diagnosis and after receiving two cycles of the MATRIX protocol, brain MRI with contrast enhancement (Fig. 11A, B) showed regression of the lesion, and PET scan showed complete metabolic resolution in terms of decreased FDG activity of the previously seen PCNSL without signs of lymphoma activity elsewhere. Subsequently, the patient received the third cycle of the MATRIX protocol without specific complications. Two weeks later, autologous stem cell transplantation (50 × 106/kg) was performed as part of the consolidation phase of treatment. Six weeks later, conditioning chemotherapy with carmustine–thiotepa was administered, followed by stem cell infusion (CD34 = 12 million/kg). The post-transplant course was complicated with mucositis, folliculitis, diarrhea, febrile neutropenia, and prolonged thrombocytopenia. Two months after transplantation, PET scan was repeated and showed complete metabolic resolution of initially seen PCNSL involvement. Currently, the patient is being followed by the hematology team; the patient is in good health and remission. The last outpatient follow-up was 8 months after the first surgery. The patient was seen by the vascular surgery (for permcath removal) and oncology teams. At this time, the patient was stable with complete remission; then, the patient was lost to follow-up. Another head MRI was performed and showed almost total regression of the lesion.

Discussion

Lymphomas in CNS are classified as primary, arising de novo from brain parenchyma, leptomeninges, eye, and spinal cord and as secondary to systemic lymphoma, which can be dural-based lesions. Secondary CNSLs are more common than PCNSLs. Most PCNSLs are intraparenchymal diffuse large B-cell lymphomas with a predilection to occur in the frontal lobe and then deep nucleic and periventricular locations; the infratentorial cerebellum is the most common location. However, primary dural-based lymphomas are rare, and even when found, they are histologically marginal-zone lymphomas. Few cases of primary dural-based diffuse large B-cell lymphoma have been reported in the literature [4,6]. Furthermore, PCNSLs are more common in immunocompromised patients with a mean age of 34 years, and they occur in immunocompetent individuals at an older age with a mean of 52 years [7]. The patient in this case report was 58 years old and immunocompetent without significant previous medical conditions. The latest review of the literature on primary dural-based lymphoma has been conducted by Quinn et al., who have found only 24 reported cases of primary dural-based diffuse large B-cell lymphoma, which confirms the rarity of the disease and subsequently the limited knowledge regarding this disease entity [8]. CNSLs have rapid response to steroids with shrinkage in size and initial remission [9]. Moreover, the initial response to steroids is associated with a better response to chemoradiotherapy and good prognosis [9]. In the patient in this case report, there was an unintentional delay of surgery for approximately 10 days, and the patient was on steroids (dexamethasone). In this case report, the failure to identify a discrete lesion of the size expected as perceived on initial imaging, despite proper surgical planning using neuronavigation, was probably due to the rapid regression of the tumor in response to steroids. This phenomenon agrees with the scientific literature reporting about the disappearance of lymphomas in response to steroids (ghost tumors) [10,11]. The pathogenesis of primary dural-based lymphoma remains unknown as there is no lymphoid tissue in the dura. It is hypothesized that it is related to chronic infection, autoimmune disease, or chronic inflammatory condition, which recruits polyclonal lymphocytes resulting in monoclonal lymphomas [6]. In contrast, the patient in this case report did not have any chronic conditions. All workups were negative, including the entire viral panel and autoimmune markers. Basic research is needed to determine the etiology of PCNSL, especially dural-based lymphomas. In the patient in this case report, the initial radiological findings were mimicking those of a meningioma: dural-based and uniformly enhanced. There was significant surrounding edema, significant diffusion restriction, and blooming in susceptibility-weighted image, which goes more with higher-grade meningioma or another high-grade lesion. One review has shown that primary dural-based lymphomas can display the “dural tail “sign, further confusing the preoperative diagnosis with meningioma [12], which did happen in the patient in this case report. Therefore, we suggest that in case of a dural-based lesion that has non-typical features of grade 1 meningioma, clinicians should consider lymphoma in the differential diagnosis and avoid steroids unless necessary due to edema and mass effect keeping in mind the ghost tumor phenomena of lymphoma.

The role of surgery in PCNSLs is limited mainly to histological diagnosis through biopsy or tumor debulking in case of increased intracranial pressure or impending brain herniation. Some studies have shown no benefit of complete surgical resection of PCNSLs; however, a recent systematic review of 244 articles has shown evidence in support of cytoreductive surgery [13]. Previously, whole-brain radiotherapy (WBRT) was the recommended treatment; however, this treatment modality resulted in a high rate of relapse and a decrease in performance status and cognitive impairment, and with the improvement in survival with high-dose methotrexate, WBRT is no longer recommended. Currently, newly diagnosed PCNSLs are initially treated with induction chemotherapy until complete radiological response, followed by consolidation therapy, to prolong the overall survival [14]. The International Extra Nodal Lymphoma Study Group-32 trial has shown that a methotrexate-based MATRIX regimen results in a good outcome and control rate in PCNSL [5], and it is the standard induction chemotherapy. Ferreri AJM, in his article “The role of autologous stem cell transplantation in PCNSL” has compared various consolidation phase treatment modalities, including beam radiation, carmustine–thiotepa regimens, and autologous stem cell transplantation, and the results showed that autologous stem cell transplantation resulted in good outcomes [15]. The patient in this case report showed a good response to treatment with almost total resolution of PCNSL with three cycles of MATRIX chemotherapy, followed by conditioning chemotherapy with stem cell infusion.

Conclusion

PCNSL is a rare entity. Clinicians should always consider it in differential diagnosis of meningioma if the radiological findings are not typical for meningioma. When there is a high index of suspicion of lymphoma, repeating neuroimaging, particularly MRI, before surgery, especially if the surgery is delayed while the patient is on steroids, may help develop a better management plan while dealing with this rare lesion. In case of lesion disappearance, falx biopsy can be an option. The aim of surgery in PCNSL is mainly biopsy or debulking to decrease intracranial pressure in case of significant mass effect.

List of abbreviation:

Primary central nervous system lymphomas (PCNSLs)

Central nervous system lymphomas (CNSLs)

Head computed tomography (CT)

magnetic resonance imaging (MRI)

positron emission tomography (PET)

fluorodeoxyglucose (FDG)

whole-brain radiotherapy (WBRT)

[emma-m-black]

Doctor White - Chapter One

Tom Koracick x OC (FanFiction)

This is a super rough draft of a Tom Koracick x OC story I've had in my head. I got a ton of chapters done, but then kind of his a block at a cliff hanger and I figure, perhaps if I post it, maybe I can figure out what to do next.

Rating is probably close to PG, don't think there is any spicey bits, pretty tame.

Chapter One:

Elizabeth walked through the halls of Grey Sloan Memorial Hospital in utter astonishment. She was finally here, the Hospital she had dreamed of working at. Tomorrow she would be in her final year of residency.

She could hear the room before she saw it. The sounds of multiple voices attempting to talk over one another as they vied for control over their conversations. She paused before she turned the corner to the staff cafeteria. Reaching down, she rubbed the palms of her hands against the dark velvet fabric of her dress. Elizabeth told herself it was to smooth out the wrinkles, but really it was to dry the sweat from her palms.

"I don't want to go in there either." Spoke a voice from behind her, it jarred her from her thoughts and her already racing heart sped up even more.

"Can you see my pit stains from back there, I had hoped this dress wouldn't show." Elizabeth let out a laugh as she turned around to see who had spoken to her.

A man quite a bit older than her stood before her. Slightly greying hair and a large smirk on his clean-shaven face. "Doctor Thomas Koracick." He began as he stuck out a hand in greeting and approached, "You must be one of the brilliant new Interns?"

"Actually I'm a transferring resident, a smart, brilliant, scared out of my mind, and regretting every moment that led me to being here all of a sudden senior resident." Tom gave a slight chuckle and glanced down to his still waiting hand. "Shit, sorry…, Doctor Elizabeth White, pleasure to meet you." She spoke as she straightened8 her back and reaching out to grasp his hand.

"White? Any relation to Doctor Wilfred White?" Asked Tom.

"Yeah. He is my father."

"I'm sorry." Said Tom, releasing Elizabeth's hand.

"Sorry?" Elizabeth questioned not use to that response when it came to her family legacy.

"That you have to deal with that ego on a daily basis. What was it like growing up with him as a father? I can just imagine what dinners must have been like." Said Tom as his eyes raked over her with a smile. "So were you planning on following in his footsteps."

"Cardio no, I'm interested in Ophthalmology."

The smile on Tom's face dropped. His mouth opened, and then he closed it, seemingly at a loss for words.

Elizabeth let out a laugh. "I'm joking. Neurosurgery is my specialty, the brain is what led me to becoming a surgeon. I had a grade two Atypical Meningioma." Said Elizabeth as she raised the hand and tapped her skull. "Had to learn everything brain related when I was diagnosed, and now all I want is brains. All I think about now is brain tumours."

"Sexy." Tom said with a smile. "The tumour, that is. I'm assuming you've had surgery, and you aren't about to enter your internship with a ticking time bomb?"

"Yeah, I was nineteen at the time."

"Reoccurrence?"

"Radiation treatments after the total resection for good measure. So far, no reoccurrence."

"And you've been keeping up with your scans?"

"Yes."

"Who was your surgeon?"

"Doctor Samuel Gravely."

"Samuel's a quack. I'll find you tomorrow, and we will do a CT, make sure he didn't mess up that legacy of a brain of yours." Tom stepped forward and placed a fist to his hip and extended his elbow toward Elizabeth. "Now come on, I want to start some rumours before your first day."

Elizabeth stared at him with wide eyes, unable to respond to his proposal. "Come on, trust me, it will give you some street cred, all the gossip tomorrow will be about you. Which gives you the advantage of standing out to all the important people." Elizabeth laughed and slipped her arm around his before he walked the two of them into the busy room, the busy room of which a good few people stopped to watch as both her and Doctor Koracick.

She could hear a few whispered words asking who she was and why she was with Doctor Koracick. It was then though that she spotted Doctor Bailey, who had also just seemed to have spotted her.

"Ah, Doctor White, I'm glad you could make it." Miranda said as she approached her. Elizabeth noticed the side eye that was given to Tom as she came to a stop in front of them. "Doctor Koracick, do you two know each other?"

"We've been bonding over her sexy brain tumour." Tom responded.

"Interesting." Miranda narrowed her vision at the older man. "Doctor Webber!"

Elizabeth watched as an older man walk towards her, she knew from her pry into the hospital's staff that this was the Doctor Richard Webber.

When Doctor Webber was in front of them, he eyed Elizabeth suspiciously.

"Doctor Webber, I would like to introduce you to Doctor Elizabeth White. She was the one I told you about."

"White…" Richard spoke as he extended a hand. "Like the Cardio…"

"Yes, Dr. White is my father, Doctor Webber."

"Doctor Bailey told me that she hired a prodigy, but I never thought…" he trailed off.

"I hope I can live up to his reputation."

"I hope not." Said Tom with a smirk on his lips. "He's a prude. No offence." He finished looking to Elizabeth.

"I'm sure we will see great things from Doctor White. She was top of her class at Harvard, and I had to offer her a great deal to get her to leave Duke."

"I would have come regardless." Elizabeth laughed. "This was always my top choice."

"Doctor Koracick, I didn't realize you were still here." Came the happy voice of Amelia Shepherd.

"Yeah, I had allowed for a few extra days to stick around, you know, in case you became a cabbage." As Tom talked, a group started to form around Elizabeth.

"And who is your friend?" Asked Amelia.

Miranda took notice of the people around them and quickly threw a sweeping hand out. "This is our new Senior Resident Doctor, Elizabeth White…" Miranda stretched out the last name, giving everyone time to process what she was saying.

"Wait like…"

"Yes." Miranda said quickly.

"Who…"

"She is his daughter."

"But I thought…"

Miranda waved her hands in the air. "Let's leave the poor girl alone, she can answer all your questions tomorrow. Now go, mingle, all of you. Including you, Doctor Koracick"

Elizabeth extracted her arm from Tom's and placed a hand to his chest instead. "Don't worry, you get to check me out tomorrow." Elizabeth threw a wink at him before walking away towards the drink table.

A dark squint was sent from Miranda to Tom. "Her brain. I'm checking out her brain tomorrow."

"I'm watching you Koracick, I'm watching you."

Chapter Two

[domono08]

Hi, On May 13th, I will be undergone brain cancer surgery to remove a large meningioma and radiation chemotherapy. The recovery time for this type of procedure is a minimum of two months. I am employed as a bartender and will have no income during the recovery period. Donations will go towards living expenses when I am unable to work. Your contributions will be greatly appreciated! Please donate whatever you can. MY GOAL IS: $1800 DONATIONS & REBLOGS ARE GREATLY APPRECIATED👏

Wow! I feel bad for you. As I have no money for I am a minor. But……..I will repost this for you.

[darklydeliciousdesires]

The Dark Passenger - Chapter Nineteen.

I’ve decided to nuke the unlock feature on this besties. It was an idea to maybe try and coax those who usually wouldn’t comment or reblog to do just that, but all it did was prompt all you lovely people who are faultless in doing such to participate more, and if shouldn’t be left to you lovely souls, you do enough! :) So yes, I’ll update once weekly going forward. Huge thank you to all of you who have engaged with this story and are still with me enjoying it. You make me smile!

Previous chapters - One  Two  Three  Four  Five  Six  Seven  Eight  Nine  Ten  Eleven  Twelve  Thirteen  Fourteen  Fifteen  Sixteen  Seventeen  Eighteen

Words - 4,093 

Warnings - 18+ content throughout, minors DNI!

Tag list - In the comments. Please DM to be added/removed

“I’ve been looking for you all morning.” The words of her sister-in-law were what roused Amelia Shepherd from her long, complex train of thoughts, looking at the scans that had arrived the evening before, for a patient Doctor Conrad Knight from St Michael’s Hospital in Santo Padre had deemed inoperable. “My god, that mass!” Meredith then continued, coming to her side and squinting a little at the images. “Meningioma?”

“Glioblastoma,” Amelia confirmed, “with a growth period of fourteen months.”

Meredith’s jaw virtually hit the floor. “Fourteen months, and it’s reached those margins? Holy cow.”

She snorted softly. “Holy cow, indeed. The patient has received six weeks of radiotherapy, but it’s done little to shrink it. That beast is aggressive if nothing else.”

“I’ll say! Anyway, I was looking for you to confirm you and Linc will be at Zola’s recital tomorrow. I have to let the school know how many of us are attending and as usual, I’m late in getting back to them.”

“I’ll be there,” she confirmed, her eyes flitting back to the scan images, “but Linc has surgery, so just put me down.”

“Okay. Good luck with that, too.” Nodding in the direction of the scans, she raised her eyebrows. “You think you can do anything?”

Amelia pressed the tip of her pen against her pursed lips, studying it, slowly beginning to nod. “It’s risky, being that this portion here is pressing so heavily against the temporal lobe from its growth through the frontal, but the rest I think should be a clean removal. I’m going to call Koracick for a second opinion, but yes, I think I can get it all. If not, then at least another round of radiotherapy should be able to kill off the remainder of it, should I deem it too risky once I’m in there and can physically see it.”  

Meredith left her to it, impressed as ever by Amelia’s grit, her confidence in herself over what other surgeons would have tiptoed into with much greater caution. She was one of the best in her field for a reason. Zooming in closer, Amelia muttered to herself, beginning to scribble notes, her mind working speedily. “Two millimetres onto the temporal, hmm... could affect his memory... possibly wouldn’t... if I came at it from... hmm, no... wait... yes! If I... yes!”

One phone call to her mentor later, sending the images for him to study, both discussing it from all angles, and Amelia was able to return to her office and make another call before she was due in surgery. “Miss Smith? Hello, this Doctor Amelia Shepherd from Grey Slone Memorial. Okay, so I have some news following our preliminary discussion. Is Mr Reyes with you currently?”

“Hold on one moment, Doctor Shepherd. I’m upstairs and he’s outside.” Camile raced, barefoot and flat out down the stairs, through the clubhouse and into the yard, finding EZ hauling large quantities of metal into a large container, after stating he felt well enough to actually be useful, for once. “Okay, go ahead.” Putting the call on speaker, she walked with him back inside, taking a seat as the doctor began to explain her thoughts.  

“Of course, before we really get into it, I would like for you to fly up here for an appointment, also so I can have you scanned here at the hospital, since we do boast much superior equipment. I will be in a much better position to know how exactly to proceed surgically after that, but at this moment, I am saying yes. I feel confident that I can remove it. If not all, then most of it. The surgery would not be without its risks, however, but we can discuss that in greater detail once we’ve actually met to begin our preliminary discussions. Now, I have free appointments commencing as of August 17th. When is good for you, Mr Reyes?”

He chose as soon as possible, scheduling with her for August 17th at 10am, thanking her for her call and more so, even considering his case viable in the first place. Camille hung up, trying to bite back her grin, not able to read him for a few moments, his face blank, eyes a little wide.  

He cleared his throat a little. “Did she... did she really just say she’s prepared to do the surgery? I’m not imagining it; this isn’t a dream? She really wants to attempt to remove it?”

Reaching for his arm, she pinched him upon his dragon tattoo. “You’d wake up about now if it was, baby.”  

“I feel... I feel like I shouldn’t be happy about this, like I should proceed with caution, not get my hopes up too much, I...”  

She saw it in him, the need for optimism, that he wanted to at least be a little bit relieved that finally, there was good news, and that such should be celebrated. “EZ, this is amazing news, of course you get to be happy about it. That tumour, up until now deemed inoperable? We just found a surgeon who is stating otherwise!”  

Her bright enthusiasm pulled him out of the veil of pessimism he’d partially slid back under, EZ shaking his head as he stood, beginning to laugh as he pulled her into his arms, lifting her from the floor, swinging her around. Finally, the light at the end of the tunnel had been turned back on. Finally, there was hope. “I can’t believe she’s willing to try! I mean, I just... fuck. It might all just be okay.”  

She held his face in her hands as he set her back onto her feet, beaming brightly. “It will be okay. She’s in Seattle. It’s a sign, a clear sign right from your mom. She told you in your dream that’s where you’d find your answer. It’s too spooky to be pure coincidence. You’re gonna be fine, I know it. I just know it. You know I’m not wrong about these things.”

It was true, she wasn’t. What Camille felt with her gut instinct was always correct, that sixth sense she seemed to have. After all, she’d been the only person in his life to know that while he was putting her and everyone else close to him through hell in his altered state, he was still in there, buried beneath the duress of the tumour. The tumour Doctor Shepherd was certain she could remove.  

“Morning, guys,” Hank spoke brightly, beginning to smile as he saw the happy faces that greeted him. “Ain’t seen you looking so happy for a while, prez.”  

“Well, I just got some good news,” EZ began, walking to him. “We found a surgeon, well no, Camille did, this is her win, and she’s prepared to operate on me. She thinks she can get the tumour out, if not all of it, then most.”  

Hank shook his head, grabbing EZ’s face and pulling him close, kissing his forehead before bear hugging him tightly. To have him so elated touched EZ to tears, since he knew that he’d been especially cruel to his enforcer in particular during the months where he wasn’t himself.  

“Damn, you’re gonna have one hell of a badass scar,” he rumbled, EZ laughing and hugging him again just as Bishop entered the clubhouse to be told the same thing, he and EZ embracing, the VP absolutely elated for him.  

“We gotta celebrate this, mijo,” he announced. “We gotta do something, get everyone down here. Hey, it’s Bella’s birthday celebrations this weekend, isn’t it? I doubt she’d mind sharing.”

“Yes, this Saturday. I know because I’m on at the club but then coming back here with all of you to party, and she’s already requested I give her a lap dance,” Camille confirmed, suddenly having three very interested pairs of eyes on her.  

“Oh really?” Bishop rumbled, his grin widening. “Can you do that for a small audience?”  

“Single clients only, no audiences,” she confirmed.

“Damn,” he exclaimed with a little nod of his head, suddenly brightening. “Can you do it again when we all get back here?”

“Bishop, is this just a ploy to see my tits?”

He shrugged, his grin widening. “Maybe.”

“Yeah, but if she even so much as flashed you, you wouldn’t know what the hell to do with yourself,” EZ joked, giving Camille a little nudge and an eyebrow raise that said one thing loud and clear. ‘Do it, it’ll be hilarious.’ It wasn’t a secret that Bishop had somewhat of a small crush on her, or as much of one as a happily married man could.  

“I’m going to work now, see you later, love you,” she spoke kissing her boyfriend before going to get her bag from upstairs, coming back down and turning back at the doors. “Hey, Bish?” Grabbing her top, she lifted it, flashing him speedily before turning and heading out, the three guys in hysterics at her antics.  

“Jesus Christ,” Bishop exclaimed, licking his lips, still laughing. “God damn, those are beautiful tits.”

EZ nodded, winding an arm around his shoulders as they began to walk towards the doors. “And guess who had his dick right up between them last night?”

Hank exploded laughing behind them, Bishop throwing a playful glare. “Oh, I hate you.”

“Envy don’t look good on you, carnan.” Going back out to the yard, they continued to work until the others showed up, EZ sharing with them his news, having his brother in tears as he hugged him, Angel overcome with relief.  

“I gotta call B and let her know, she’ll be fuckin’ over the goddamned moon, bro. And yeah, she ain’t gonna have a problem sharing her day.” When the day came, Angel made it so special that Bella had no problem sharing it with anyone, especially not after she saw her gift from her husband.  

“Can I take this thing off yet?” she asked, her vision obscured by the black bandana Angel had tied around her head, leading her across the yard to where her birthday present had been stashed.  

Coming to a stop, he beamed, excited for her reaction. “Okay, now you can look.” Taking off her blindfold, Bella nearly died on the spot to see her dream car, a Range Rover Sport black edition, with a big bow stuck on the roof. Her scream? Deafening.  

“Oh my god! Oh my bloody fucking bloody god! Oh bloody hell, you got me... you... it’s... oh my god, I love you so much! Thank you, big sexy!” she squealed, throwing her arms around Angel, showering his face with kisses.  

“You’re welcome, baby.” Sometimes, it paid well to not be able to put large chunks of cash in the bank, Angel deciding to spend a huge amount on at least half paying off a near brand-new car for his wife in cash, the rest on monthly credit to an amount he could comfortably afford. It was her twenty-first, after all. She deserved something fancy, and it still kept him under the radar. Large, fancy purchases of course were a strict no-no because of the attention they drew from certain governmental department eyes, the greater push of heroin making each of the guy’s very comfortable financially, but also on the radar.  

Camille came down from the front of the clubhouse, presenting Bella with a big bag of gifts and a huge hug and kiss, having no idea what to get her as a big present, so deciding on lots of little ones. Inside resided all her favourite British candies and snacks and a pair of large hoop earrings with little cherry amber gems, and a pendant that matched, Bella excitedly taking out her current pair to put them into her ears along with all the rest.  

She and Angel left shortly after, Bella jumping behind the wheel of her new ride, pulling a wide eyed, wide mouthed face of utter excitement after starting the engine and giving it a few revs, Camille cracking up before waving them off, heading back inside. She’d booked the Saturday off for a change, wanting a little bit of downtime since she’d been busy between the salon and the club, needing nothing but to spend time with her man. When he was awake, that was.

Gone now were the days of nausea and headaches plaguing him now he was managing to keep his medication to combat both down, but the other most prominent after effect of the radiotherapy was still beating his ass, EZ sleeping on average twelve hours a day, sometimes more. When she arrived upstairs, though, she found him awake, looking through his phone as he did upon waking, Sally curled up at his side.  

“Was that engine I heard starting up Bella leaving in her new toy?” he asked, Camille slipping her feet from her dark grey fluffy slides (or the dead muppet slides, as EZ loved to call them in tease) and moving to lie down beside him, Sally thumping her tail happily and moving to lick her arm.  

“It was, and she absolutely loved it. Angel’s taking her for breakfast, and then I think the plan is for you guys to meet here at 7pm before you all head over to the club,” she spoke, EZ nodding, looking down at his stomach as it rumbled loudly. “Want me to sort that out?”  

“What?” he asked, raising an eyebrow. “The rumbling stomach, or the morning wood?”  

“Both?” Sally was nudged from the bed, both falling into kisses, a very hot, quick morning session enjoyed before they showered, EZ shaving while Camille went to sort some breakfast. It was while she was scattering granola and a variety of seeds over the banana yogurt and fruit that she turned to see him, leaning against the bathroom doorframe, smiling, but with something there in his eyes that made her question it. “For a man who just blew his load all over his girl’s boobies, you look a little troubled.”

He shook his head, scratching the side of his neck as he laughed softly. Pulling the t shirt he held in his hand on, he approached, taking the coffee cup she handed him with thanks. “It hits me at times, just how lucky I am to have you, after all the shit I put you through. I would have never blamed you for walking away if you had, especially after I hit you.” He dropped his head, staring at his bare feet. “It still haunts me. If Bish hadn’t gotten in the way, I know I’d have kept going, too. I dream of it sometimes, these nightmares that swirl in my head, imagining losing control, bad things happening.”

It was the kind of turn Camille hadn’t expected the morning to take, her boyfriend placing his coffee down and covering his face with his hands for a moment, taking a deep breath, pulling himself together again. How easily she could have been Gaby. How fortunate he was that he’d had people there to halt him before his tumour had dictated she be another body of a beautiful soul he made quietly disappear.  

“Nightmares aren’t real, and I’m not naïve enough to know that it could have gotten much worse, should we have been alone that night, but it isn’t going to happen again. Doctor Shepherd is going to make sure of that.” Handing him his breakfast with a kiss, she squeezed his arm, moving over to the small lounge area and taking a seat. “Come on, this is meant to be a happy day. Bella’s finally at legal drinking age, you’re celebrating the fact we found the aforementioned surgeon, so turn your frown upside down.”  

The sweet simplicity she showed, how she’d taken it all in her stride, it still amazed EZ. For someone who could be so unguarded, soft and trusting, there was a side to Camille that was nothing but raw strength, her faith unshakable. Her faith in him unshakable. Lesser women would have run from much less, and he counted himself so very fortunate to have her there by his side still. “I mean it, you know. No more lamentations. I know you get a little melancholy about it all from time to time, but I don’t want you to be. I just want you to love me.”

He kissed her cheek, nuzzling her softly, licking a little yogurt fleck from her top lip. “There’s no danger of me doing anything less than love you completely.” Such words left her feeling nothing but glowing, kissing him again before they finished eating, spending the rest of the day relaxing, EZ napping too so he’d have enough energy to enjoy what was to follow later that night.

They arrived at the Luna Lounge at just gone 7:15pm, Bella being greeted by a big bouquet of flowers and balloons from Camille, a free drink too since it was her birthday, the bartender also doing some shots with her, which too were on the house. After that, she was swiftly led away for her birthday dance, emerging just under ten minutes later, her face an absolute picture. For Angel, it could have cost him ten times more than it did, and it would have been worth every last cent.

“Are you alright there, B?” he asked, his voice rippling with a current of laughter as he viewed his wife, Bella grinning widely.

She leaned close to him, giggling in a way that had him snort laughing in a second. “I think I’m bi, because bloody hell, the full-on lady boner I have right now.”  

That was it, Angel was gone, completely cracking up in hysterics as he put his arms around her, kissing her hair. “I swear, she amped it up just to be a tease! I mean she... she... I...” she floundered, only reducing him to further hysterics. “Blimey!”

“I can’t... I can’t fucking breathe,” he hissed. “Best sixty bucks I’ve ever spent, shit.”  

Bella then turned to EZ, her face making him crack in a second. “And you get that woman, all over you, on a nightly basis.”

“I do,” he confirmed, swigging his beer.

“I think you’re gonna have to share her with me,” she nodded, sipping her drink. “It’s only fair I get to take her home at least one night a week.”

“Yeah, and let me watch, damn!” Angel exclaimed.

“Oh no, there’ll be no pimping of my lady to you! You keep your pussy to yourself, B.”

“What if I save you a seat next to me for the viewing?” Angel asked, EZ pausing lifting the bottle to his lips, his grin suddenly widening.  

“I’ll give it some thought.” When Camille joined them, she found the whole thing hysterical when it was relayed to her, swiftly being asked for another private dance from the group, Gilly deciding he wanted one. For Amelia. She did wonder why none of the guys asked her for themselves, until it swiftly dawned on her that it was a respect thing, being that she was El Presidente’s girlfriend, of course they wouldn’t. Samuel and Jonah, the two newly patched in members of the MC were taken care of by Tallulah and Raven, though, Nestor finding himself led away by Mai for the same, who excused herself briefly to whisper in Camille’s ear.

“This dude I have here, is he single?”  

Camille nodded. “Oh yeah, and he has a big thing for Japanese chicks.”

Mai straightened, fluffing her hair, her grin suddenly wide. “Ding, ding, ding! Jackpot!” Thanks to the Santo Padre charter of the Mayans, the girls walked away with a very tidy wedge that night, Mai and Tallulah in particular, Bella and Amelia getting them to give their guys a dance each, too. When Angel sat back down beside his wife, it was all she could do not to pee her pants at the look on his face.  

“Happy, are we?” she asked, Angel grabbing her, pulling her onto his lap.

“I got me the hottest woman in here, and she’s cool with buying me a lap dance. Happy don’t quite cut it. Imma show you just how happy you make me as soon as we get back to the yard,” he vouched, Amelia suddenly leaning into their space.  

“Bathroom out for ten minutes again?”

He sneered playfully, prodding the end of her nose. “You’re just salty that it ain’t you I’m giving ten minutes of heaven to, Garcie.” They left at close to 10pm to continue the party back at the clubhouse, Camille able to duck out early since Mai was covering for her by staying on late. Once back, firepits were lit, drinks were poured, and more people piled in, Bella screaming in delight at the surprise that was her old friends from the salon arriving, racing to hug Bridgette, Gloria and Ruby in turn.  

“Shit, who's the tall black chick hugging your wife?" Nestor asked, Angel giving him a double take.  

“That’s Ruby,” he began, his grin widening. “And she’s a drag queen, bro.”

Nestor dropped his head for a second, quickly straightening with a thoughtful face. “Hm. Maybe Bella isn’t the only one wondering how bi she might be tonight.”  

Angel blew out a mouthful of beer with the force of his laughter, doubling over, Nestor in fits at his reaction. “You horny, French braid bitch, shit.” It was a scene EZ witnessed, one that he was glad of, his brother seemingly over his dislike of Nestor enough to actually be welcoming of his place in the club more than he had been before. His attention was then distracted by another arrival, or more precisely, Angel’s loud, drunken reaction to it. “Marge! Marge is here!”

He had a huge soft spot for the diminutive redhead, getting to know her better when she’d called in the previous week after having car trouble, Camille telling her to take it down and get Bishop to look at it for her, who was the resident automotive genius. While waiting, she’d sat talking to the elder of the Reyes brothers, becoming just as fond of him as he was her.  

“Hello honey. Oh, that’s a very big hug,” she laughed as he ran to her and wrapped her in his arms, somewhat smushed against his chest. “Where’s wifey? I have a little gift for her.”  

Angel was touched by that gesture, only ever having met Bella once before, but obviously being told that the celebration she’d been invited to was also for her birthday as well as EZ’s news about the surgery. “Up here, come on.” Taking her hand, he led her back to where their little group was sitting at the front of the clubhouse, throwing himself down on the couch, Marge passing the gift bag to a delighted Bella, kissing her cheek.  

“Marge!” she exclaimed, pulling out a gorgeous, huge jar candle from the bag, opening it up and giving it a sniff. “Oh, that smells beautiful! Thank you!”

“You’re welcome, honey,” she nodded, moving to greet EZ.  

“Hey, ma,” he chirped, standing to hug her, Marge touched by his use of the term ma to refer to her as. “No John?”

“No, sweetheart. He has a migraine, but he sends this for you.” Opening her bag, she pulled out a bottle of Casamigos Blanco, EZ’s favourite tequila. “And I am instructed to do shots with you, so go fetch some glasses.”

“No need,” he began, before calling out to Anton, the newest hopeful looking to join the ranks of the MC. “Hey, prospect! Shot glasses!”  

Marge turned to him with a raised eyebrow. “It’s good being king, huh?”  

He grinned, wrapping his arm around her. “It’s never dull, I’ll give you that.” Shortly after, they were joined by Camille and Amelia, who’d been locked in conversation with Gloria, who coincidentally Camille knew from beauty school, Gloria a former part-time tutor there on the hairdressing course, the women often crossing paths while the former was training to be a beautician.  

As he sat back, doing shots with his girlfriend and her mother, the party in full swing, EZ took a moment to pause as he watched it swirl around him. This Doctor Shepherd they’d found, well, she’d better be as good as she seemed, because no matter his past wobbles, his resignment to his fate, this was his life, and he loved it. He didn’t want to check out at thirty-five, no way.  

He had way too much good there to live for. All he needed now was to further cut out the bad.  

[bengiyo]

My School President Ep 10 Stray Thoughts

Last week, we went to the beach! Sound learned about Gun's relationship with Tinn while they worked on songwriting, and revealed his feelings for Win to Gunn. Yak was there seeking redemption vicariously through his juniors, and managed to help them in spite of his overbearing nature. Tiwson was also there, and as far as I'm concerned was there for Por. Sound managed to confess his feelings through music, and Win acknowledged them. Tinn and Gun want to kiss so badly, but they are still holding to the rule. The unattached characters performed a cover dance.

Tinn had such hopes for dates with Gun during this break. I hope he managed to prepare for the entrance exams at least and didn't just regress to expressing his feelings through Scrabble.

Tinn's family home seems way too big for just three people. Glad they're doing well?

I can't believe Gun mushed Tinn in the face as a hug denial. Still, it's probably the right call begun Gun is falling hard for Tinn too.

I'm sorry, but the wireless earbuds just don't feel as intimate as crowding close together to share wired ones.

Tinn's mom woke up, sensed Tinn not focused on schoolwork, and had to come check.

These two are just so endearing.

New intro hype!!

Of course Kajorn is the reason she confirmed Tinn lied.

That's right, Sound. It's time for Gun to ask the big questions: Who are you? And What do you want?

I agree with @kyr-kun-chan that Gun playing along with Tinn about the holy Chinzilla, and then teasing about having many boyfriends is fun, because we don't often get playful pairs.

Gosh, I really love these two. The Wave 3 BL boys are doing a great job.

I'm glad we were warned in the preview about Gim falling at work.

Meningioma? A tumor??

I wonder how the secrets he's been keeping will blow up for Tinn.

Por knew he had to look cute to ask a favor of Tiwson.

Aof cameo? 1000Scores??? A Tale of Thousand Scores?? What is happening?!?

Can't even enjoy the boyfriend meal because Tinn is being eaten up by this secret.

Lot of head slapping and shoving this episode.

Tiwson remains the greatest supporter. Just the absolute best boy.

The Tiwson/Por crumbs continue to confuse.

Aw, and now Gun is thinking that he's not a priority, before even worse learning Tinn knew something about his mom.

Fourth is good.

I'm glad Gun knows all that Tinn has been doing for him, because I doubt Tinn would have ever told him.

Please drink the product placement water to feel better, not the nondescript water from the meal scene earlier.

Sometimes it's especially interesting watching stories like this when you're older. You know what the answers are for the characters, but they're young and it won't matter until they believe it themselves. Where is Natasha Bedingfield?

Not me crying over how much I love Chinzhilla.

Why is Tinn's phone unlocked??? Maybe it's just because he's at home. I will applaud the mom for not digging through the phone, but still she knows it's Gunn now.

Now Tiwson is making them scramble for shirts in 4 days? Look at the hustle on these boys.

Of course Gun's at the hospital. He might lose his mom.

Oh, gay boys and their moms. I love Gim and Gun so much.

I like Gun's song for Tinn.

Okay, I cried at Gim watching the performance before her surgery.

I'm so relieved they didn't leave us in limbo about Gun's mom.

I think I get the cliffhanger. It's the primary emotional hold of the show.

Back to the beach next week I see.

[just-indi]

Hi, On May 13th, I will be undergone brain cancer surgery to remove a large meningioma and radiation chemotherapy. The recovery time for this type of procedure is a minimum of two months. I am employed as a bartender and will have no income during the recovery period. Donations will go towards living expenses when I am unable to work. Your contributions will be greatly appreciated! Please donate whatever you can. Goal: $1800

WHAT. (There’s no way in hell this isn’t a scam, also I’m a minor with no money errr)

[spartalabouche]

Hi, On May 13th, I will be undergone brain cancer surgery to remove a large meningioma and radiation chemotherapy. The recovery time for this type of procedure is a minimum of two months. I am employed as a bartender and will have no income during the recovery period. Donations will go towards living expenses when I am unable to work. Your contributions will be greatly appreciated! Please donate whatever you can. MY GOAL IS: $1800 DONATIONS & REBLOGS ARE GREATLY APPRECIATED👏

boooo bad scam. dont donate to this person their blog was made literally today also im sorry what kind of username is mysticfartwombat for your brain surgery fund blog

[lov3rgrrrl]

Hi, On May 13th, I will be undergone brain cancer surgery to remove a large meningioma and radiation chemotherapy. The recovery time for this type of procedure is a minimum of two months. I am employed as a bartender and will have no income during the recovery period. Donations will go towards living expenses when I am unable to work. Your contributions will be greatly appreciated! Please donate whatever you can. Goal: $1800

scam :(

[tw33k-tucker]

surgery to remove a large meningioma and radiation chemotherapy. The recovery time for this type of procedure is a minimum of two months. I am employed as a bartender and will have no income during the recovery period. Donations will go towards living expenses when I am unable to work. Your contributions will be greatly appreciated! Please donate whatever you can. MY GOAL IS: $1800 DONATIONS & REBLOGS ARE GREATLY APPRECIATED THANKS 👏

I'm sorry but I am LITERALLY a child, again I'm sorry, but you might wanna send these to an adult instead of a 12(almost 13) year old, because I do not have a job to help, because I am a child

I hope you get your goal though

[lastlycoris]

What surgeries do you have scheduled?

Three surgeries.

Two brain aneurysm coilings. We're going to go through the carotid artery, snake a catheter into the circle of Willis / brain vasculature, and deploy a coil in a sizable anterior cerebral artery aneurysm - an aneurysm is essentially a focal sac that develops in a blood vessel - think of it as a balloon under high pressure - a weakness that can -pop-.

The aneurysms in these cases are big and are at risk of popping with devastating consequences. Unlike the middle meningeal artery I mentioned before, the vessels involved (circle of Willis) directly supply the brain.

Ever experienced a water pipe leak? You have a hole in the water supply somewhere, and you're no longer able to get water from the faucet due to the inadequate water pressure. That's what happens when an aneurysm pops - the brain loses a good portion of its blood supply, and you have what we called a hemorrhagic stroke with all the loss of movement and function that goes with it.

It's actually a bit more complicated than that. Blood is also an irritant in the brain and can cause the brain vessels to constrict in a phenomenon known as vasospasm, which again deprives the brain of oxygen and nutrients.

So we're going to coil these aneurysms off before they pop and do that.

----

Third case is a pituitary macroadenoma resection. Essentially, the guy came into clinic with a very specific visual field loss known as bitemporal hemianopsia - he lost the outermost fields of his vision with the inner part of his field intact.

That specific visual loss pattern tells us that something is affecting the optic nerves in a particular way, specifically the optic chiasm where the two optic nerves share fibers before going to the eyes. We were not surprised to find a pituitary macroadenoma pressing from under the optic chiasm on the head CT - pituitary adenomas are the second most common type of intracranial tumor (meningioma is first).

We are going to remove the tumor by going through his nose and entering into the sphenoid sinus, where the sella turcica is - the place where the pituitary lives. And yes we will be pulling out bits of tumor from his nose.

The advantage of this is that I do not have open up the skull to get to the tumor - and by not opening up the skull, I don't have to interact with the rest of the brain. That is a good thing.

Small thing to worry about is that patient has annoying variant anatomy involving the sphenoid sinus, known as a post-sellar sphenoid sinus. Normally you have a centimeter or so of bone between the sinus and where the brain stem lies. People with post-sellar sphenoid sinuses don't have that.

And yes, poking the brain stem is bad.

--

That's my outpatient schedule for the most part. And then they stuck me on emergent call duties for Trauma for the afternoon / later part of the night.

The things I do to avoid going back to jail.

[stillnotyourmusebitch]

Since I've been gone . . .

We found a large meningioma in my sister's brain. Which fuck you NHS taking a look at a larger woman and thinking nah it's tension headaches and lose weight all those years ago.

But she had the surgery yesterday and I'm at the hospital waiting for visiting hours again to see how she is.

She is awake and alert she seems happier if that makes sense.

So I'm stuck living in a Travelodge room for three nights as the hospital is not close to our home at all. I told her when they found the meningioma I was with her through thick and thin. She's my big sister and I love her

But she is on the mend and that is all that matters.

This is more rambles than anything but more a shit update. I suck at updates

[stillnotyourmusebitch]

I agree doctors need to step up. My sister has had migraines for over 4 years and the doctor always said things like it's tension headaches, lose weight blah blah blah. When she was explaining about being tired all the time to the doctor they put it off as exercise more. But she ended up in hospital with blood transfusion and iron drip coz she was so anemic and don't get me started on the fact my sister has to have brain surgery in June this year because she had to have a 4cm meningioma removed. All because doctors kept putting it down to her being fat.

She is doing better now but if she was given an MRI all those years ago and the blood tests she wouldn't have had to go through all that shit.

This is why fat shaming can have tragic consequences.