Brian’s Story: Meningioma

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“Carefree” is the word Brian uses to describe his life back then.

He was 39 years old, happily married and the father of three children under the age of 5.

“Life was busy, but that felt normal,” he says, reflecting. “The only lingering health issue was consistent headaches for a period of two-plus years.”

That lingering health issue turned out to be bigger than Brian could have imagined. Brian’s primary care physician, Deborah Gerdes, MD, was bothered enough by it to order an MRI of Brian’s brain to rule out anything serious. The MRI, which was supposed to be reassuring, revealed a small mass: a meningioma located above Brian’s left ear.

Brian was referred to John M. Tew, MD, a Mayfield Clinic neurosurgeon and Clinical Director of the UC Neuroscience Institute, in late October 2009. And on December 1, Brian made the transformation from brain tumor patient to survivor. Brian suffered permanent hearing loss in his left ear, but the benign tumor was successfully removed, and Brian has required no further treatment.

“The chance to be 40 years old and watch my wife and kids grow old is priceless,” he says. “I could not have gotten through this ordeal without the support of family, friends, co-workers and Dr. Tew and his staff.”

Brian’s use of the word “ordeal” is entirely normal. From his diagnosis to his brain surgery to his recovery, he experienced a flood of emotions and, post-operatively, some physical pain.

“Before the surgery there was worry about a great unknown,” Brian recalls. “You get diagnosed with a brain tumor, you make the decision to have surgery to eradicate it and clean your brain out. Anxiety starts to kick in and you wonder, ‘Is this going to hurt?’ There is the uncertainty about your future, your children, your job.”

Brian declined to go online and read about his type of tumor or other patients who had undergone a similar surgery. But he did benefit from a conversation with another brain tumor survivor, who put him at ease and walked him through the basics. “I didn’t over-the-top it, I didn’t take it to the extremes,” Brian says.

One thing Brian could control was his level of fitness, and he got in the best shape possible in order to expedite his recovery following surgery. He worked out three to four times a week, engaging in Pilates and a functional fitness class designed to elevate the heart rate at intervals. Brian’s final workout was on a Sunday, two days prior to his surgery. “I remember going into surgery thinking, ‘I’m a little sore from that workout – my legs are a little tight,’ ” he recalls. “The exercise helped take my mind off my difficulties.”

The day before his operation, Brian had an MRI. The technicians fitted him for a headrest, which would secure his head during image-guided surgery, and placed markings on his head. “They put pads on my forehead where they would put their brace, and I looked a little like Lurch, from the old Addams Family TV show,” he recalls with a laugh. “I wore a tassel cap all day and night around my kids. They were young, and they naturally kept wondering why Daddy was wearing this hat indoors.”

The next day at the University of Cincinnati Medical Center, Dr. Tew and his team used image-guidance technology to “localize” the tumor, establishing its boundaries for a clean removal.

“You can’t see how far this tumor extends with your eyes or with a microscope,” Dr. Tew explains. “But you can see it on the imaging, the brain scans. Working with image-guided surgery provides us with a preoperative map that shows the tumor’s breadth. As a result, we know how much of the carpet of the dura, a protective, leather-like covering of the brain, to remove.”

Because Brian’s tumor was positioned on the left vocal cord and swallowing nerve, Dr. Tew and his team closely monitored Brian’s nerve function during the operation. “We were able to save that completely,” Dr. Tew notes. “Brian’s voice, swallowing, and speaking are excellent.”

Brian recalls waking up and seeing Dr. Tew and his wife and family. He also remembers experiencing a significant amount of pain during the first 36 to 48 hours.

“It tests your mettle, how strong you are,” Brian says. “During a post-surgery MRI, which takes 35 to 40 minutes, I remember lying on the board thinking, ‘I don’t think I can make it.’ But I did get through it. I think to some degree it’s a mind game: you have to prepare yourself from a physical and mental standpoint. Overall, I had a pretty positive outlook. I never thought that my life was threatened, or that I wouldn’t recover. I took the ultimate positive approach.”

Brian began feeling much better after 48 hours and was discharged three days after surgery. Ten days after surgery he was working part-time from home, and four weeks after surgery he was back at the office.

The significant residual impairment is a complete loss of hearing in his left ear. Dr. Tew theorizes that the loss stemmed from a virus that invaded Brian’s hearing nerve.

Because people evolved to listen in stereo, loss in one ear makes hearing difficult in a loud or open room, such as a restaurant. “You really have to look people in the eye,” Brian says. “I’m starting to learn how to read lips. If I’m at a dinner party, I try to position myself to maximize my ability to follow conversation. My wife will always take my dead side and give the other person my positive side. And sometimes I just tell people, ‘I really can’t hear you.’ ”

On the bright side, Brian sleeps soundly at night. Lying on his right ear with his deaf ear exposed, not even the crickets bother him anymore.

– Cindy Starr

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