Surgeon’s evaluation of my MRIs
On this page, I shall share my surgeon’s evaluation of my MRIs. Dr. Gregory Lekovic writes very well. His well-written e-mails has been a great comfort to me as his patient. They let me know that he deeply cares.
February 17th, 2010
After reviewing my January 2010 MRIs of the whole spine, brachial plexus and lungs.
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Hi Yvonne,
Happy New Year! I did receive your MRI in time to review it with our radiologist. The largest tumor of the brachial plexus is 8.5 x 3.0 x 3.6cm starts at about the C5 level and extends into the chest behind and inferior to the axillary artery. The lower tumor does not look like it is a contiguous lesion. It might be tumor of the long thoracic nerve. You also have a third tumor on the right side, running horizontally in the muscle fibers of the subscapularis muscle. It is probably arising from a muscular branch of the nerve supplying this muscle. Finally, he found another tumor at the level of the first rib that is 3.8 x 2.5 x 2.0cm. You also have the tumors we know about on the left side, and a small cyst or tumor in the thyroid gland. This was not, however, a true brachial plexus study. One reasonable option at this point would be to observe the tumors and watch for growth or symptoms. If you wish to pursue this surgery further, presumably on the theory that this largest tumor has already grown to a large size and you do not want to give it the chance to cause you problems, then I would recommend that we get another MRI here in LA before you would have surgery. This might have to be done at an outside location (i.e. Another MRI facility). The necessary MRI study is called neurography and it is a special sequence developed to follow the signal of the nerves directly. This could be helpful because it could help us distinguish whether this large tumor is a plexiform schwannoma or not. Plexiform schwannomas are those that involve more than one fascicle of the nerve, or even the entire nerve. I would guess that it is, because of its size and your history of NF-2. Plexiform schwannomas cannot be removed in entirety without sacrificing the nerve of origin. The tumor could still be debulked, at less risk to your function.
On another note, we also reviewed the most recent MRIs of your brain that we have, from December 2009. You have a tumor in your right jugular foramen that has increased in size by a centimeter in superior-inferior dimension since last year. This tumor most likely arises from either the ninth or tenth cranial nerve. Weakness of this nerve may cause you to have changes to your voice, making it hoarse or ‘breathier’. This sound like the symptom that you describe having noticed recently. Is it possible for you to have your vocal cords examined there? In particular, we are looking to see if you have weakness of your right vocal cord. We could also check on this next time you come to LA.
Let me know what you think,
Sincerely,
GPL
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