Next Steps!

Today, we met with Erica's amazing team of doctors. 
* Dr. Park - Neurologist
* Dr. Oniell - Neurosurgeon
* Dr. Wilkening - Neuropsychologist
* The rehabilitation team
* Wynn Bird - Epilepsy Program Cooridinator

We visited with each one of them in length, and after a 3 hour appointment, we walked away more educated about the brain than we ever expected!  Here is a summary of our visit.

The data collected from the extended EEG and the neuropsychology evaluation indicates that the seizures most certainly are a symptom of the tumor.  Since seizures cannot be controlled with medication, surgery is the next step.  There are two procedures that are options for Erica due to the nature of the tumor and the location.

Option 1:  Standard Temporal Lobectomy
This procedure involves removing the tumor, tissue around the tumor and the hippocampus. 
Cons - This is a more invasive surgery and requires more recovery time.  Memory decrement is a concern as well as small visual deficits. 
Pros - This procedure has been performed for many decades and is well documented and proven effective in curing epilepsy due to a brain tumor. 

Option 2:  Visualase Procedure
This procedure involves a new laser technology that targets only the tumor. 
Cons - Only 300 of these procedures have been completed in the nation.  With this being a newer technology, there is less data to support the effectiveness of the procedure.
Pros - All the data thus far suggests that this procedure is highly effective.  This procedure has been conducted at Children's Hospital 6 times.  In all 6 cases, all patients are seizure free after surgery.  Another pro for this procedure is that it is the least invasive and recovery is only a few days.  Memory decrement is less likely with this procedure. 

Both options were described in much, much
 more length, but in the end, the team of doctors recommend the 2nd option.  If this option is not effective, we can still fall back to option 1.  To prepare for surgery, Erica will have several more tests.

Wada Test:  https://www.epilepsy.com/epilepsy/surgery_wada
This test  will allow the neurologists to look more closely at Erica's language and memory centers. The temporal lobe controls both of these functions and the tumor is very close to one of her memory centers, the left hippocampus.  The test will determine if the left hippocampus has been negatively impacted by the seizures and to determine if the right hippocampus can compensate for the left if it has been damaged and/or needs to be removed.  This test requires Erica to be admitted for the day at the hospital.  She is really nervous about this procedure, but all the doctors assured her that it is mostly uncomfortable and not painful.  For more information about the procedure, view the link above.  Basically, she is having an angiogram.  The "anesthesia" will put each half of her brain to sleep and test the other half for memory and language.  They told her to expect times where she may say really strange or funny things, and other times when she can't talk or move a side of her body.   Sue will be able to be with Erica most of the day, just not during the actual test.  She'll be away from mom for 1-2 hours. 

Visual Field Test:  To be scheduled with our local eye doctor to get a baseline for her vision capabilities.  

MRI Test:  Just before surgery, an MRI test will be taken again to map the brain and make measurements. 

Surgery: http://www.visualaseinc.com/
Erica will be asleep during the entire procedure.  The Visualase Procedure will take about 6 hours to complete.  The link above shows a neat video animation of the surgery and lots of information about the technology.  They will complete a biopsy of the tumor first.  Then they will insert a catheter to the tumor and use the Visualase technology to "burn" the tumor with use of an MRI for precision.  Erica will only need about a 1 cm incision!  More than likely, she will not need to be moved to ICU after surgery.  They expect her to return to recovery unit and more than likely can leave for home the next day!!  She can expect very little pain.  No headaches and no pain other than the 1cm incision!  They said she can return to school and activity when she feels ready to.

Timeline: 
Visual Field Test - End of September
Wada Test - Beginning of October
MRI Test - Week of surgery
Surgery - 1 week after Wada Test - Mid October

We are hopeful for a healthy girl by Halloween!  I think Erica should be a brain surgeon for Halloween.  Who knows, maybe she'll aspire to be one when she grows up!