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  • NicoleDeRosa

My First SURGERY

Updated: Nov 13, 2023


How It Started




I had an MRI with and without contrast performed on May 31, 2023.
The findings were as follows....

  • A 1.9cm heterogeneously enhancing mass of the LEFT frontal bone, grossly unchanged compared to CT scan.

  • The differential diagnosis includes: Hemangioma, Atypical Fibrous Dysplasia + Intraosseous Meningioma.

  • Tissue sample may be of benefit.

  • Focal susceptibility of the LEFT parietal subcortical white matter.

  • This is non-specific, but could represent a small cavernous malformation.

  • Mass of the LEFT frontal calvarium, measuring 1.9 x 1.6 cm on image 21 of series 9. This mostly involves the outer table, extending into the scalp soft tissues. Postcontrast images demonstrate heterogeneous enhancement.

  • There is linear enhancement within the diploic posterior to the mass, which could represent prominent blood vessels.




How Its Going.....




Here I am in pre-op on the right looking oh so fabulous once I changed into my hospital gown + cap.

My incredibly sweet nurse, Mary Jane had me change into this red/orange hair cap + hospital gown. The color of the cap is significant as it tells the staff that I am not yet ready for surgery.

For the next hour or so, Mary Jane monitors my heart rate, gives me a pregnancy test + inserts a needle where they will be administering medicine once I'm in surgery.


Before I put on my hospital gown, I had to wipe my tummy, legs + neck with chlorhexidine wipes. Sidenote....a week prior to surgery I had to use chlorhexidine (antiseptic foaming cleanser) to wash my hair everyday for 5 days until day of surgery.

I don't know how or why, but I was able to fully put my mind at ease on the morning of surgery. I didn't over analyze or over think the surgery + I pretended I was on a movie set....lol... I think I was still fully in shock that this day was here + it was actually happening.

My amazing nurse, Mary Jane was so sweet. We spent time chatting + getting to know one another + we learned that we are hepatic hemangioma "sisters". (...more about that in another post....)

I met my anesthesiologist, Dr. Joselito Numa + he was also so kind + funny. I just felt in such good hands + ready to get the "show on the road". Dr. Danish stopped by one more time to see if I had any more questions before surgery. We discussed what material (titanium mesh or Mimex cement) would be used to fill in the area in my skull once the mass was removed.

Now that I was ready for surgery, Mary Jane had me switch to wearing a green hair cap which signified to everyone that I was now prepped + ready for the operating room.

It's so wild to me that I'm smiling here (this is before drugs...lol) but it just goes to show how much I was able to transport my mind + not overthink everything.

I know I joked above about pretending I was on a movie set, but it truly felt that way. From the moment I was wheeled into the bright operating room, to the propofol going into my arm,
to the anesthesia mask going over my mouth, everything just felt so surreal. Lights, camera, action.

This is me post surgery looking INCREDIBLY HOT. lol....if you know me, you know that I have terrible insomnia, so being put to sleep for a bit was a welcome change. Although, waking up super groggy with a numb scalp + trauma to my head was not.

This part was harder to convince myself that I was on a movie set. This was now the worst part. As I got dressed + Mary Jane brought me down in a wheelchair with my Dad to the car, my mind began swirling about what my head was going to feel like once the numbness + propofol wore off.

That night + in the following weeks, it was migraine after migraine. I just took that time to catch up on sleep + try to shake my insomnia by getting back onto a proper sleep schedule. One night I had a migraine that was so bad + the prescribed acetaminophen-codeine (pain medication) did nothing to help. I called Dr. Danish's answering service at 4am + he so kindly called me right back! Thank you Dr. Danish...you're an absolute LEGEND for that!

I was so fearful about washing my hair + the wound. I didn't know what it was going to feel like with this "new normal" of having a numb scalp + traumatic wound + trying to make sure that it didn't get infected. I started second guessing myself, questioning should I have just let the mass grow + deal with it or was this just me back to my old ways of overthinking everything?

My scalp was numb in some areas + super sensitive + painful where the incision was. There were dissolvable stitches in my head + I also had some residual clear Dermabond that was put over the incision that was stuck in my hair + there were painful sores that were developing on my scalp.

I emailed photos to Dr. Danish + Nurse Devon of the sores on my scalp. There was a lot of redness, so Devon called in Keflex (an antibiotic) just in case it was an infection or an allergic reaction to the Mimex or Dermabond. We also decided to move up my post-op appointment to September 15th, once I finished the antibiotics so they could inspect the area sooner.

It's now, November 3rd and I'm still on the road to recovery + just easing into a "new normal" which includes keeping the area on my scalp clean + applying Bacitracin zinc on it daily.

I'm going to make an appointment with my dermatologist to check out my scalp sores but other than that, I'm starting to have some more feeling in areas of my scalp that I didn't have before which is excellent news!


I want to say a MASSIVE THANK YOU to:

Dr. Shabbar Danish for the care in which he was able to remove the mass with minimal scarring + his swift follow up answering all my questions!

Devon Orzano, APN for her wonderful bedside manner + swift follow up answering all my questions!

Nurse Mary Jane for her comfort, gentleness + incredible bedside manner!

Dr. Joselito Numa, my anesthesiologist for his humor + answering all my questions!

MASSIVE THANK YOU as well to the wonderful: Dr. Sean Munier, Mary Mallue, Stephanie Mendoza + Hazel MenaNaranjo.



Dr. Danish and Devon were so kind answering all my questions, pre + post op so I encourage anyone going through any type of procedure or surgery to ask any + all questions to their doctors, no matter how crazy, silly or weird you think the question is because I feel like most of the questions swirling through our minds actually create more unnecessary anxiety + stress + once I asked my questions, it made a world of a difference to my mental state going into surgery.


All The Pre-Op QUESTIONS I Asked

My NEUROSURGEON


Since this was my first surgery every I want to be at ease with my decision + have all my answers prior to the procedure. Below are the questions that I asked.


Question: I'm pretty sure you told me, but what approximately is recovery time post-surgery?
Answer: We can do this as outpatient surgery. You will feel sore for a few days.

Question: Oddly enough, the biggest concern for me is having a plate put in my head...since the growth is near my upper left forehead hairline, can I forgo the plate?
Answer: You don't want to do that. This will leave a hole there, and will not be cosmetically pleasing. I can just drill down the osteoma, and make it flush with your skull, and not put a plate in. This should be ok, but in general you have to accept a risk that it may grow back.

Question: Is there any reason for the plate besides aesthetic purposes?
Answer: Not really, but it is an important reason.

Question: Would I need to shave any part of my head at all?
Answer: NO

Question: As far as post-surgery, would I be seeing you for a follow up visit a few weeks after surgery? Answer: 2 weeks after surgery

Question: Is there any risk that the metal plate could exacerbate your headaches after?
Answer: A very small risk.

Question: Overall, what are the risks with this type of surgery?
Answer: Infection, and regrowth of osteoma (if we just burr it down). Overall low risk.

Question: Is there a video anywhere of a similar surgery that I can view?
Answer: Below is an example video (note that everyone's case is slightly different):


Question: What is the size of the incision?
Answer: About 2 inches. If we go behind the hairline (better cosmesis) it will be longer.
Question: What is the approximate amount of time of the surgery?
Answer: 1 hr
Question: What is the aftercare like? Answer: Making sure the incision is clean. not much else Question: Approximately how many of these surgeries have you performed? Answer: Too many to count. These are common. Question: I was reading my MRI report again where it says: "There is linear enhancement within the diploic posterior to the mass, which could represent prominent blood vessels." That last part has me concerned. Will this mean that you won't be able to remove the mass in its entirety because of these prominent blood vessels or will you not know until you are performing the surgery? Answer: Not true. We will be able to remove it in its entirety unless you decide on not having a plate put in. Question: You are calling it an osteoma. Is that confirmed that is what it is? Answer: I will confirm with pathology. While it is possible that these can be more "aggressive," it is extremely unlikely Question: Will a biopsy need to be done + if so, what possible findings could be found?
Answer: Yes. I will send for a biopsy.


All The POST-Op QUESTIONS I Asked

My NEUROSURGEON



Question: Supraorbital nerve (which as you know, provides sensation on the scalp): It still feels like my scalp on my left side is numb. Is this because it's still swollen or is it a possibility that my supraorbital nerve could have been injured?
Answer: This is pretty common post-op and usually gets better as swelling and inflammation subside. Sometimes the nerve endings do not line up perfectly when the incision is closed. Typically this also gets slowly better over time, but sometimes the incision itself remains numb.


Question: I've had a headache that hasn't gone away in the past few days. Is this normal for a headache post-op to linger without stopping for a few days? Answer: Headaches are common after surgery. Usually it goes away with Tylenol, sometimes something a little stronger is needed (like Fioricet). Let me know if you need a prescription.

Question: What material was used to recontour the area? Answer: Mimex cement

Question: Will I be receiving a full report of what was done in surgery?
Answer: Yes. You can access your report in MyChart.

Question: Cerebrospinal fluid leak / fistulas OR post-op periorbital ecchymosis / Subgaleal hematoma: Is this something that I possible have or have to worry about post-op?
Answer: No

Question: Do I still need to do follow up CT or MRI post-op?
Answer: CT scan at 6 months.

Question: Will the osteoma return? Were you able to completely excise the growth along with any surrounding bone to prevent regrowth?
Answer: The osteoma is completely removed. We will follow it and decide how long to follow it for.

Question: Do you have photos from our surgery that can show me before + after?
Answer: I do not routinely take pictures. I do it if a patient has specifically asked me for it in advance.







If you live in CHICAGO...



When I went down a little rabbit hole of research, I found the above photos + quote from Board Certified Plastic Surgeon, Dr. Anil Shah, MD of Shah Aesthetics based in Chicago. So, if you live in Chicago and need this procedure, you may want to contact his office for a consultation.
"Someone in the office showed me a video of a patient on YouTube who had an unsightly forehead bump removed. The technique that was being done was a direct incision over the forehead bump. The issue with this approach, however, is that this type of removal leaves a noticeable scar that may not be pleasing to the patient. My approach is different. Making a small incision in the scalp, I can remove the forehead bump endoscopically. Placing the small incision in the scalp hides the scar in the hair. Using this technique also minimizes downtime, limits swelling + can be performed in an office setting."


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