Prognosis After Removal of Epidermoid Tumor

One of Michael's biggest concerns has been about how he will "be" after the operation.  Originally, it seemed his "side effects" would depend on the timing of the tumor's removal... getting it out before it caused permanent damage.  And since the neurosurgeon would be poking around inside his brain, passing dangerously close to the auditory canal, margin for error was very slim.

However, with the less-invasive approach to removing the tumor, the surgeon will barely enter his brain.  We understand that when the tumor is gone, the nerves will expand into their normal space and Michael's symptoms will begin to disappear.

I haven't been able to easily locate specific expected results following the operation; I'm sure it's different for every case.  However, there are two general concerns with this type of procedure.  First is being able to remove the entire tumor.  Second is the possibility of recurrence.  This is old information, but following are some statistics from a 1998 study of 54 patients followed for a 13-year period:

• 57% of tumors were completely removed
• Higher total removal rate in patients where tumors confined to a primary location
• 30% with subtotal removal experienced symptoms again after 8.1 years
• 100% with total removal remained asymptomatic
• 95% recurrence-free survival rate for patients with total removal
• 65% recurrence-free survival rate for patients with subtotal removal

Source:  Epidermoid Facts

What can we conclude?  Well, there's virtually no chance of Michael not surviving the operation or coming out of it physically incapacitated.  Since we don't know how many of his symptoms are truly attributed to the tumor, we don't know how many will disappear or if they'll disappear completely.  And we don't know timing for anything.  The length of the surgery as well as recovery is expected to be much shorter than originally anticipated, but will depend on the patient.

Since Michael is mostly healthy except for the thing in his head, we are assuming the best.  There's really no reason to indicate we should assume anything else.  We may know more early next week when we meet his doctor in person.  I'll be sure to chronicle that here...

Symptoms of Epidermoid Tumors

How did we know something was wrong inside Michael's head?  Well, I'm not sure when we would have noticed had he not gone to the hospital on that fateful day.  But at the rate his symptoms increased following diagnosis, it probably would not have been long after.

The following information comes from Epidermoid Brain Tumor Community website.

Because epidermoid brain tumors grow slowly, they may not cause symptoms or be detected until they have become fairly large.  In the skull base, symptoms can be specific to a cranial nerve being compressed, such as the cranial nerves for smell, taste, vision, facial sensation or hearing.

In general, brain tumor symptoms may include:

• Atypical headaches (Michael has frequent headaches)
• Vision
• Hearing (Michael sometimes feels a vibration inside his ear)
• Dizziness (perhaps Michael's most distressing symptom)
• Seizures
• Sharp pain on side of face
• Facial nerve weakness (Michael says his nose is numb)
• Difficulty swallowing (another distressing symptom Michael experiences)
• Aphasia (speech word find, slurring, understanding words)
• Weakness or paralysis in part of the body
• Taste senstation
• Limb sensation (Michael experiences weakness, tingling and numbness)
• Changes in sensory perceptions
• Changes in personality and/or thought processes
• Abnormal pulse, breathing rates, blood pressure (does snoring count?)
• Difficulty walking or balance issues (along with the dizziness, this has affected Michael at work)
• Fatigue or sleepiness (Michael is always tired)

As I review this list once again, I'm amazed about how many of Michael's... well, "issues"... may in fact be due to his tumor.  I have so often poo-pooed him whenever he blamed something on "the thing in his head".  But will removing it now get rid of all these symptoms?  We'll look at his prognosis tomorrow...

Epidermoid Facts

What exactly is this thing in Michael's head?  The following information comes from The Epidermoid Brain Tumor Community website.

The epidermoid is a tumor-like mass.  An epidermoid tumor is a benign (i.e. non-cancerous) neoplasm of the brain.

In general, there are several ways to acquire this type tumor:

1. By skin cells that are deposited in the wrong place during neural tube closure causing "ectodermal elements" to be trapped.
2. Skin cell penetration, such as a fall, infection, or puncture such as a spinal tap.
3. Radiation exposure.

The epidermoid tumor (cyst) consists of an outer covering (the capsule part of it) and an inner mixture of skin cells and fatty acids.  The capsule is about the thickness of wet tissue paper, and the inside contents are the consistency of cottage cheese.  These tumors are usually slow-growing and generally diagnosed in the middle twenties to the late fifties.  They do grow, but at a slow rate, and if not removed entirely, can grow back.  The most common sites in the brain for these tumors are the cerebellopontine angle and the pituitary area.  In surgery, removal of part of the capsule must often be left in because of adhesion to cranial nerves or the brain stem.

These epidermoid tumors have also been referred to in the literature as epidermoid cysts, epidermoid lesions, intercranial cholesteatoma, pearly tumor, or tumour perlee (French).  Cholesteatomas are an older name and now considered a misnomer.  They are also found in the ear, some being congenital and some acquired.