Adventures in Neurosurgery (and my Accompanying Neuroticism).

Yep, that's right. I've bitten the bullet and decided to go ahead and take care of the old "incidental anuerysm" they found on my MRI during Sinus Kerfuffle of Near Death 2009. Two weeks ago, I met with the neurosurgeon here in Charlotte who was the first and strongest recommendation of my neurologist in Chapel Hill (ie, he's who she's trust with *her* brain). Beforehand, I was under the impression that I had two treatment options:

1) drill a hole in my skull and have them fix it by putting a clip around the bubble, which was risky because of the whole "drilling the skull then taking my brain out of my head and putting it back" part, but was safer in that, if something went wrong (mainly, a major bleed) they could stop it much more easily, OR

2) a vascular approach, where they go up through my carotid artery in my leg and put little coils in the bubble itself from within (and/or a stent to keep things blocked off), which is much safer and less invasive (not to mention less painful) than skull drilling, assuming all goes well; but if all *didn't* go well, particularly in the event of a major bleed, I would be, well...screwed, in the most major, hope you've got your assests allocated way possible.

Ergo my anxiety. Thankfully, the shape of your aneurysm can somewhat dictate which treatment option is most likely to be successful, so it takes some of the pressure off of being "the decider"(sorry, I couldn't resist). After meeting with Dr. Bernard, however, I was made aware that I'd have to have an arteriogram first, just to determine the shape of the aneurysm in order to proceed at all. The only real difference between the arteriogram and the vascular treatment is that the arteriogram alone is usually done under concious sedation, rather than general ansethesia, but given my supercystic, cougheriffic inability to lie flat on my back and perfectly still for any significant amount of time, I'd need GA for both anyway. So, Dr. Bernard suggested, why don't we just put you under once, go in, do the arteriogram, and if it turns out that the aneurysm is treatable by vascular means (as most are), go ahead and do that too?

Sounds good, I think, but then my pesky paranoia about that whole, "bleeding out and dying" risk crept back up, particularly given my physiological penchant for being the exception to such rules, and I said, "So isn't this really great if all goes well, but if something goes wrong when you're in on the vascular approach, there's really nothing you can do?" At which point I was gloriously told I had been misinformed; yes, if there's a bleeding issue, it can be...quite an issue. However, the chances of such things are slim to none, as the only way that really happens is if someone were to, say, nick the vessel, and Dr. Bernard himself will be doing the procedure, so the chances of this slim to none careless thing happening are even slimmer to noner than the basic slim to none statistics. Otherwise, pretty much any other problem they may run into would be best handled from *within* the vessel, so it's really with the craniotomy that you'd be screwed in the event of a non-bleed-out problem. Also, the recovery time is almost laughable for the vascular approach; I'll only have to stay in the hospital for a day or two for observation (albeit in the ICU, yelch), then go home, and spend 3-7 more days not lifting anything over 5 lbs, not driving, and not staying bent at the hip very long, lest my artery incision get all twisty and excited and start to spew. Seriously folks, I'm having brain surgery and missing one day of class. I marvel at modern medical technology!

However, as any CFer knows, simple, straightforward non-CFish procedures are rarely simple or straightforward, and the same applies here. First of all, as you may remember, my kidneys went on strike and refused to negotiate during the Sinus Kerfuffle of Near Death 2009, and have only really bounced back all the way in the last 2 months or so. So while I'm elated they bounced back at all, the fact that this whole arteriogram shindig involves some pretty heavy-duty contrast is no bueno. Hopefully, they'll be able to use the same "kidney-friendly" protocols they used for my MRA, but it's definitely TBD at my pre-op appt. (These poor fools don't know what they have coming...hopefully the 3-in binder I'll have in tow will be a clue, muahahaha).

Secondly, and more importantly...you know how there are "social smokers", people who don't like, carry ciggarettes with them, or smoke with any real pattern or regularity, but smoke enough when they're out with other smokers that they can't really call themselves "non-smokers?" That's me with hemoptysis (aka, "coughing up blood" for the uninitiated). I'm not what you would consider a straight-up "bleeder." I've never had a really massive bleed, I've never even really had to consider being embolized; there's usually a pretty clear cause-and-effect relationship to my bleeds (i.e, coughingcoughinggaggingcoughingcoughinggagging...pop! or drinking a touch too much when I'm on the downslope, lungswise), and they rarely come close to that sketchy "1/4 cup" line. However, I am not such a light and infrequent bleeder that this is not a concern.

Unfortunately, one of the major contributing factors to Carolina's Neurosurgery's superhigh success rates is that they put everybody on Plavix AND Asprin for a few days before the procedure, and keep them on it for at least a few days after. Hopefully you see where I'm going with this: "social bleeder" + blood thinning agent + anti-clotting agent = Holy crap, are you kidding me? Also unfortunately, this scenario requires me to weigh "significant risk of significant hemo episode" with "risk of stroke and subsequent paralysis and/or death." I'll be having my Vit. K levels checked and start working on bringing those up to speed this week, as:

Hemoptysis < death =" Plavix">

Other than that, and the general risks that go along with general anesthesia (ice chips, anyone?), it actually should be relatively simple and straightforward (although I must say I love how, like our geriatric-level medicine lists, CFer's "other than that" lists are freakishly-normal to us, what-the-hell to reg'lar folk). In the unlikely case that my aneurysm can only be repaired by slicing into my head, I'll wake up, heal, and reschedule, simple as that. Well, not quite "simple as that" overall, just "simple as that" as in "no added potential immediate drama or chopping into Jessica". Fun fact, the craniotomy requires the shaving and subsequent removal of a portion of skull "about the size of an oatmeal cookie," that, given the location of my aneurysm, would be centered over my right temple. It would then take another 6-12 weeks to "grow back in"...both my skullcookie and the little hairs so unfortunately shaven from its surface. Just in time for job interviews, but too soon for Halloween.

So.

Let's all keep our fingers, toes, and any other twisty appendages crossed that I wake up with this sucker taken care of, shall we?