The 2nd Surgery

Sorry this has taken a while to get to but I've been playing catch up for a while now.  Here is what occurred for us to have a 2nd surgery for Dana.

During 1st Surgery

During the 1st surgery, Dr Deshmuhk entered Dana's brain from the right side of her head, just above the ear.  The image to the left (hand drawn...sorry, not exactly a lot of images on Google that have what we were looking for) is of the right hemisphere of the brain but it's inverted (b/c that is how they do things).  The incision is around 3 inches long, no hair was removed and they did not have to do a controlled break of her jaw in order to get access to the brain.  After reaching the skull, a hole the size of a nickel was made and they entered the brain.  After tunneling through the brain they reached the void that the cavernoma made.  Upon entering this void, a large amount of very old blood came out. After that they could see the cavernoma but it didn't look like the  raspberry...instead it looked like a carpet of blood vessels.  He believes that the cavernoma popped during the Scotland event and that is why a bunch of blood vessels were lining the voided area like a carpet.  He proceeded to remove the cavernoma/blood vessel carpet, remove the old blood and then cleaned the brain.  Some of the brain was yellowed, that happens after the blood rests on the brain and the iron from the blood leaches into the brain.  Iron isn't good for the brain as it promotes seizures, so we had to get that out of there.

After 2nd Surgery

Dr Deshmukh was pleased with what he saw in this cavity after the void was clean, he could see the water canal/column/ventricle (all the same thing) as well as the carotid artery.  After inspecting the area, he did not see any more cavernoma on those two important pieces and that was very good we didn't have to touch those things.  The ventricle is circled in blue and the artery is in red.

The next morning, we had to do a MRI/CT scan so he could triple check that the cavernoma had been removed fully.  

After reviewing the imaging the cavernoma was still there in the area and he was shocked by this.  The only explanation was that the cavernoma had split and grown behind the ventricle membrane at some point in her life.  Based off of how large the cavernoma was there initially there was no need to break into the ventricle and explore in the brain...you just don't do exploratory surgery on the brain.

Dr Deshmukh explained to us in great detail what the situation was and gave us the option of going in a 2nd time or not.  The reason we opted to do the surgery again was b/c this remaining portion could have bleed in a week, month, year down the road and we'd be in the same exact spot we were in a few weeks ago.

We were so close to giving Dana a cure for this that we did not want to walk away.  

The risks were just as much as before (seizures, brain swelling) however because he had to go into the ventricle we were unsure how far he had to go in there to remove the cavernoma.  Also, once breaking the membrane to get inside the ventricle was done, there was a risk for spinal fluid leaking excessively (little bit is fine, a lot not so much).  Lastly, the carotid artery was in the general area too which is kind of a big deal.

After being told all of this and instantly being in shock we knew the right answer was yes, let's do it.  As quickly as we said yes, Dr Deshmukh had everything ready and we were whisked away into the OR and in 45 minutes we were having brain surgery...the same exact position we were in the day before.  

They went into the same exact way they did before, he opened up the ventricle and there it was. That cavernoma/son of a bitch was hiding behind the membrane and was quite large in size (almost as large as the portion that was in the voided area).  After removing what he could see he saw that the cavernoma was wrapped around the carotid artery.  This obviously isn't a good thing as this artery controls the left side of the body and any issues/complications from removing the cavernoma could result in paralysis....a catastrophic event.  He also told us later he felt this artery had a fissure vessel supplying the cavernoma with blood, this alone was not a good thing and amazing not terrible happened before (aneurysm). If that wasn't enough, there was evidence of more blood touching the brain as the Hippocampus was yellowed with iron deposits as well as another portion of the brain (can't remember if it was the Amydgala or Medulla).  He had to remove brain from these parts and that has it's own risks as well....short term memory, vision and personality.  Those components will heal in full over time so anything we lost should come back eventually....minus the personality.  An hour and a half later, Dr Deshmuhk spoke to me about the surgery and informed me of how much larger this cavernoma was.  They underestimated it and unfortunately there was no way to tell this until going through the first procedure then doing imaging afterwards to see if they got it all.  He told me that after the surgery he followed Dana to the recovery room and waited there with her until she woke.  After doing so much in a sensitive location he had to make sure she was OK.  She woke, he asked here some questions, she responded, before he could ask her to move her left arm she raised it...a sign of relief.  If that wasn't enough, Dana apologized to him for having a cavernoma.....must have been the drugs right?  Now it was time to make sure she was who she was still.  I went into the ICU room with my stomach in a giant knot.  I got to the doorway....she saw me and said, "Mark".