My Story

Welcome to my hastily built blog site. My name is Naomi Ishisaka and I set this up to keep friends and family updated on the prognosis and treatment of my recently diagnosed brain tumor – a sphenoorbital meningioma. I will be undergoing a right frontal-temporal craniotomy with orbital reconstruction (brain surgery) on Tuesday, Sept. 15 at Harborview. I can’t tell you how much I have appreciated all the love, support and offers of food I have already received from my wonderful friends, family and particularly my office at OneAmerica, who has extended such a sense of reassurance. I love all of you and am reminded of my many blessings every day. If I have not been able to talk to you in advance personally, I am sorry, this has all happened really fast.

MRI of brain showing my tumor and right eye probtosis (protrusion).

MRI of head showing brain tumor. Size about 4.5 cm x 4.5 cm.

HOW I GOT HERE (ABRIDGED)

For a long time, I had been having issues with my right eye. It was frequently tearing up and more recently a film had begun to develop over my eye. It always looked swollen but a number of different eye doctors said there was nothing wrong.

Three days before surgery

In mid-August 2009, I began to have sudden and fierce headaches. After this happened a number of times, I went to my primary care provider who ordered an MRI. After one panic-induced false start, I finally had my MRI on Sept. 2 with the aid of 6 MG of Ativan. On the next day, my ARNP said the MRI showed a brain tumor and she was referring me to a neurosurgeon. It was an incredible shocking and difficult week coming to grips with it all and trying to figure out what it would all mean. I knew very little about anatomy and nothing about tumors. It was all very scary.

In the subsequent days, I took a crash course on brain anatomy, tumor types, classifications, locations. I learned a lot, including the fact that as brain tumors go, a meningioma is a relatively “good” kind to have, because it is often benign (although not always) and because its location on the top of the head makes it easier to remove. Unfortunately, while that is true, the location of mine (behind the right eye) makes it more complicated. In addition, the fact that the tumor has permeated my bones is additionally problematic. There are also complex nerves in the “skull base” where my tumor is located requiring a high level of skill to remove. The sphenoorbital meningioma is definitely not the best kind of meningioma to have.

The neurosurgeons finally saw my MRI Sept. 8 and then asked me to come in immediately. After meeting with Harborview’s world-class neurosurgeons, they recommended removing the tumor as quickly and as completely as possible to avoid any potential loss of eyesight or further damage from the tumor. Because of the fact the tumor has invaded the bones around my eye, those will need to be removed as well. A titanium mesh will be used in its place.

They have scheduled me to check in for craniotomy surgery on Sept. 15 at 6 a.m. During the surgery, they will look at the tissue to determine its malignancy or lack thereof. The tumor will also be “classed” into one of three types of tumors, depending on aggressiveness. I will likely be in Harborview ICU for 1-2 days and then in the hospital for a 7-10 days after that. After that, I will be recuperating for up to 6 weeks at home. For a more comprehensive and clinical presentation of the above information, you can read my sister’s much better recollection. More details on my exact location will be posted to this blog under “Contact” as soon as we have them. Thank you all again for the love, support, encouragement and kindness you have all showed me. Despite all this, I am very, very lucky person to have such an incredible community around me. – Naomi

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Notes by Toshiye Ishisaka

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Naomi Ishisaka
Appointment at Harborview Medical Center – 09/09/2009

Background:
Naomi had an MRI last Wednesday (09/02/2009) that was ordered based on the emergence of severe, sudden headaches about four weeks prior. It was also observed that her eye’s showed asymmetry with pronounced proptosis (bulging). She has also experienced dizzyness in the last few days. The MRI clearly identified a tumor, and it is suspected to be a meningioma.

Naomi’s MRI films were sent from PacMed to Harborview on Friday (09/04/2009) and the surgeons at Harborview looked at them early this morning (09/09/2009). She was asked to come into Harborview within the hour.

Following arrival at Harborview today, she met with a RN, a LPN, both of her surgeons, the Patient Care Coordinator, and the anesthesiologist RN for pre-surgical instructions. Everyone at Harborview was wonderful and provided excellent 1:1 attention. Naomi is feeling very positive about her outcome. Here is a brief bullet point summary of the day.

General Surgical Information:

• Naomi’s surgeon (Dr. Sekhar) is the 6th highest rated neurosurgeon in the world.
• Due to what was identified as bone and eye involvment, the surgeons believe it should be removed as soon as possible because the ossified tumor is pushing against Naomi’s right eye and threatening her vision as well as causing severe headaches.
• Bone involvement for meningiomas in this area (spheno-orbital) is unfortunate but not uncommon.
• Surgical resection is the only treatment option based on the size and position of the tumor.
• It is expected that the surgeons will be able to remove 98-99% of the tumor tissue.
• Because of the bone involvement a large section of bone around the orbit will be removed and a titanium mesh, held in place with bone cement will take its place. Seeding new bone growth is not possible due to the size of the area to be removed.
• During reconstruction of the removed bone/eye socket, the neurosurgeons also have access to plastic surgeons in they feel out of their depth, but since they are both rock stars in their field, this will probably be unnecessary.
• The main risk in the surgery is to Naomi’s eye function; specifically the muscles that control movement.
• Personality changes are not probable because the tissue they will be resecting is not incorporated into the brain.
  

Tumor Identification:

• The tumor is suspected to be a meningioma.
• Pathology will examine a frozen slice of tissue during surgery  to confirm and also identify the type of meningioma (Type 1 – ok, Type 2 – atypical, Type 3 – anaplastic/metastatic/bad). This assessment in 90% accurate, and helps direct the surgeons about how aggressive they need to be in removing tumor tissue.
• The resected tumor will be sent to pathology for positive identification and the results will be back within 2 weeks.
  

Hospitalization:

• Naomi will be in admitted at 6AM Tuesday, September 15th
• Surgery will begin at 7:30 to 8AM and last for 4-6 hours
• She will spend 1-2 days in the intensive care unit (ICU), and is expected to be able to move around at the end of that period
• She will then be transferred to the acute care unit and spend 4-6 days there, the nurse has put in a request for a private room.
• She will be sent home when the doctors have confidence that she can meet all of her needs and care for herself.

Medications:

• Anesthesia and Antibiotics will be given on the day of surgery
• Corticosteroids, an anti-epileptic drug, narcotic pain-killers, and digestive aids will be given after surgery. Other meds will be provided as needed.
  

At home:

• Naomi will need someone with her (though not constantly) for the first week she is home to help with meals, cleaning, and possibly with hygiene.
• She will need 4 additional weeks of at-home recovery with friends and family available to help out – total post op recovery time is expected to be 6 weeks.

Later On – Effects of Surgery

• Seizures may occur and anti-epileptics medication will be given for two weeks after surgery
• There is a risk to eye function based on the proximity of the tumor to the muscles that control the eye