My First SURGERY
- NicoleDeRosa
- Nov 3, 2023
- 9 min read
Updated: Mar 14
How It Started
I had an MRI with + 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, looking oh-so-fabulous after changing into my hospital gown and cap.
My incredibly sweet nurse, Mary Jane, had me change into a red/orange hair cap + hospital gown. The color of the cap actually meant something, it told the staff that I wasn’t quite ready for surgery yet.
For the next hour or so, Mary Jane monitored my heart rate, gave me a pregnancy test + inserted a needle where they would administer medication once I was in surgery.
Before putting on the gown, I also had to wipe down my stomach, legs + neck with chlorhexidine wipes. Side note: a week before surgery, I had to wash my hair every single day for five days using chlorhexidine, an antiseptic foaming cleanser. By the time surgery day arrived, I felt like I had done enough disinfecting for a lifetime.
Oddly enough, on the morning of surgery, I managed to keep my mind completely at ease. I didn’t overanalyze or spiral into my usual overthinking. Instead, I pretended I was on a movie set. Seriously… lol. I think part of me was still in shock that the day had finally arrived + this was actually happening.
Mary Jane truly was amazing. We spent time chatting + getting to know each other, and somehow discovered that we’re hepatic hemangioma “sisters.” (More on that story in another post!)
Soon after, I met my anesthesiologist, Dr. Joselito Numa. He was incredibly kind + funny, which immediately put me at ease. I genuinely felt like I was in good hands + ready to get the show on the road. Dr. Danish stopped by one more time to see if I had any last questions before surgery. We talked about the material that might be used to fill the space in my skull after the mass was removed, either titanium mesh or Mimex cement.
Once everything was ready, Mary Jane had me switch to a green hair cap. That color signaled to everyone that I was officially prepped + ready for the operating room.
It’s wild to me that I’m smiling in this photo + this was before any drugs! It just shows how well I managed to transport my mind away from fear + anxiety. I joked earlier about feeling like I was on a movie set, but when I was wheeled into the bright operating room, it honestly felt exactly like that. The lights. The equipment. The controlled chaos. From the propofol going into my arm to the anesthesia mask placed over my face, the entire moment felt surreal.
Lights, camera, action.
Then… blackout.
Post-surgery, this is me looking INCREDIBLY hot. (If you know me, you know humor is my coping mechanism.)
Anyone who knows me also knows I have terrible insomnia, so being put to sleep, even medically, was honestly a welcome change. Waking up, however, was a different story. I was extremely groggy, my scalp was numb + my head had clearly been through a lot.
At that point, it was a little harder to pretend I was still on a movie set.
As I got dressed + Mary Jane wheeled me out with my dad to the car, my mind started racing. I couldn’t stop wondering what my head was going to feel like once the numbness + anesthesia fully wore off.
That night + for several weeks after, it was migraine after migraine. I used that time to try to rest, catch up on sleep + reset my terrible sleep schedule.
One night, the pain was so intense that the prescribed acetaminophen-codeine did absolutely nothing to help. At 4 a.m., I called Dr. Danish’s answering service. To my surprise, he called me back almost immediately. That kind of care meant the world in such a vulnerable moment.
One of my biggest fears was washing my hair + dealing with the wound. I didn’t know how it would feel living with this “new normal” , a numb scalp, a healing incision + the constant worry about infection. At times I started second-guessing myself. Should I have just left the mass alone + let it grow? Or was this simply my old habit of overthinking everything creeping back in?
Parts of my scalp were numb, while other areas, especially around the incision were extremely sensitive + painful. I had dissolvable stitches, leftover Dermabond glued into my hair + painful sores developing on my scalp.
I emailed photos to Dr. Danish + Nurse Devon so they could take a look. Because there was quite a bit of redness, Devon called in a prescription for Keflex (an antibiotic) just in case it was an infection or possibly a reaction to the Mimex or Dermabond. We also decided to move up my post-op appointment to September 15th so they could inspect everything sooner after I finished the antibiotics.
Fast forward to November 3rd + I’m still on the road to recovery, slowly easing into a “new normal.” Right now, that means keeping the area clean + applying Bacitracin zinc daily.
I’m also planning to see my dermatologist about the scalp sores. The good news is that I’m starting to regain feeling in areas of my scalp that were previously numb, which feels like a big win.
I want to say a massive thank you to the incredible medical team who helped me through this experience:
Dr. Shabbar Danish, for removing the mass with such care + minimal scarring + for always responding quickly to my questions.
Devon Orzano, APN, for her wonderful bedside manner + constant support.
Nurse Mary Jane, for her gentleness, comfort + kindness during such a nerve-wracking day.
Dr. Joselito Numa, my anesthesiologist, for his humor + reassurance.
And another huge thank you to Dr. Sean Munier, Mary Mallue, Stephanie Mendoza + Hazel MenaNaranjo.
Dr. Danish + Devon were incredibly patient answering all of my questions before + after surgery.
If there’s one thing I learned from this experience, it’s that you should never hesitate to ask your doctors anything, no matter how silly, strange, or small the question may seem.
Many of the fears we carry into surgery come from unanswered questions + uncertainty. Once I started asking everything that was on my mind, it made a world of difference in my anxiety + helped me feel far more mentally prepared for the experience.
All The Pre-Op QUESTIONS I Asked
My NEUROSURGEON
Since this was my first surgery ever 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 + 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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