Arriving to Barcelona, Spain
29th of December, 2020
I arrived on . The trip took around 9 hours, and I arrived safely after having taking high doses of Boswellia, as per the recommendation that Michelle Gerencser gave me. The trip itself had no issues at all! (thanks to you, Michelle)
Meeting the Neurosurgery & Doing fMRI
I met the the Neurosurgery in Europe – Dr. Bartolomé Oliver, PhD. He is the heads the Neurosurgical Department at Centro Médico Teknon. He is leading 9 Neurosurgeries in the hospital and he takes selected complex patients (and I was one of them). He was trained in Sweden, Switzerland, Canada, and the USA. He has 45 years of experience.
He explained in details what to expect during the surgery and what will happen post surgery. He also had me do another Functional MRI and blood work (few tests) on the same day.
The blood tests had some new readings outside of the readings, and I could not know the reason this took place (the tests are Complete blood count, VSG, Platelets, Blood glucose, Total bilirubin, Creatinine, Urea, GOT and GPT, Alkaline phosphatases, and Electrolyte Panel). You can download the blood tests here. (I wonder if these readings showed up differently because of what I did few weeks before traveling as I was on Ketogenic Diet, and I took 12 HBOT sessions)
The Functional MRI took place in another hospital because he said that the best ones are there. Once I arrived there, I found that Dr. Bartolome was there too. Dr. Pujol and Dr. Deus worked on my case for the fMRI . One of the doctors has 28 years experience, and he said he was the first doctor who worked on fMRIs in all of Europe. He explained to me the outcome explaining that one part that has the largest tumor area is safe to cut off, but the area that is related to words and memory is not safe to be cut. Below are the key images from the fMRI
Dr. Bartolomé stated again that 70% of the brain tumor area will be removed while the other is most likely won’t be touched.
It is important to know that I have communicated to three fine Neurosurgeries in the United States, and one in Amman, Jordan and all of them looked at the MRIs and they all said that only 70% of the surgery is possible (and that the surgery is recommended and must take place immediately). They all said that the new tumor is going to be either Stage 3, Stage 4 or a combination of both.
Pre-Operative Coagulation Assessments/Tests
One of the doctor took around an hour of assessments (questions, games, photos-to-names, …etc). She stated that there are areas above average, and others below average. The ones I was challenged with were finding words for selected photos, and remembering the photos if I am asked after few minutes.
The plan is that parts of these tests will be done again just before surgery and during the surgery when I am awake to compare my situation to what will be resected during this surgery.
I had asked them to take videos and photos, and they were kind enough and they shared that.
Jan 4th, 2021: The Surgery
I was at the hospital at 9 AM and was bored a few hours.
At 2:00 PM, I took a specific shower to clean head before surgery. At 2:30 PM said good bye to wife, and went for surgery.
First, I did an X-Ray, and that showed that everything is alright. Then around 3:00 PM, I was in the surgery room (looking nice and comfortable).
The surgery itself took place at 3:30 PM and finished at 10:30 PM (8 hours)
Photos and videos took place during the surgery. That was kind of Dr. Bartolomé as per my request when I saw him on the first day.
Tools and Techniques During Surgery
Dr. Bartolomé said that during the surgery, the following will take place:
- Awake craniotomy
- Neurophysiological and Neuropsychological intraoperative monitoring
- Ultrasonic aspirator (CUSA)
- Kinevo for fluorescein guided resection – GLIOLAN (5-ALA) protocol
The doctor used the fluorescence-guided to be able to see clearly the high-grade (stage 2 and stage 4 areas) cells, in order to ensure to resection the right areas. You can watch this video that another doctor shared how the high-grade is much easier to see during surgery.
I met all the doctors, and they explained to me the process. They put me in a comfortable setting and put many devices in the back, on the head and other places. After they made sure that I am in the comfortable set up and location, I was given something to sleep. I started reading to 10. Despite that I wanted to count to 20, I slept after counting 3 only :)
Opening the Brain
I was told that it will take an hour after my brain is clean and ready to be worked through. They took it in 45 minutes (15 min less). How come? well, the doctor said that obviously the surgery on 2009 was not closed properly. Dr. Oliver said that they were surprised given it’s weak open outside. Lucky me, I had no hits on the brain since then!
The surgery took place at 3:30 PM and finished at 10:30 PM (around 8 hours)
When they woke me up, I told them several times that I am sleepy and want to sleep (I don’t remember that). The doctor was patient and gave me 15 minutes to wake up.
I do remember the first two minutes, where they started asking me the targeted questionnaires. The Neuropsychologist did the dperative coagulation assessments in English, and had a colleague who did them in Arabic too. The team told me that I actually did a better job than the time they did it an hour (before surgery). That’s why the doctor decided to resect the area without waking me up again (it was planned to be done twice).
Fluorescein Guided Resection
The photos below shows that during the resection, the doctor did not find any tumor in the colors that the GLIOLAN was to show. The doctor did not share that fact with me post surgery, and wanted to see what’s the purpose that no Stage 3 nor Stage 4 tumor showed up. He wanted to wait until the Pathology shows up.
Tumor Resection Work!
They videos shows parts of areas that they cut off, and these are 4 videos, where each of them are less than 5 minutes each. You can see them here if you feel comfortable watching those videos.
I decided to put the images of the first brain tumor resection versus the newer one.
Clearly, the amount that was cut is significantly larger.