McCain’s Surgery May Be More Serious Than Thought, Experts Say
By DENISE GRADY and ROBERT PEAR
JULY 16, 2017

The condition for which Senator John McCain had surgery on Friday may be more serious than initial descriptions have implied, and it may delay his return to Washington by at least a week or two, medical experts said on Sunday.

The Senate majority leader, Mitch McConnell, has already announced that votes on a bill to dismantle the Affordable Care Act will not begin until Mr. McCain’s return. A statement released by Mr. McCain’s office on Saturday had suggested that he would be in Arizona recovering for just this week, but neurosurgeons interviewed said the typical recovery period could be longer.

The statement from Mr. McCain’s office said a two-inch blood clot was removed from “above his left eye” during a “minimally invasive craniotomy with an eyebrow incision” at the Mayo Clinic Hospital in Phoenix, “following a routine annual physical.” Surgeons there are not conducting interviews. Mr. McCain’s communications director, Julie Tarallo, said further information would be made public when it became available.

A craniotomy is an opening of the skull, and an eyebrow incision would be used to reach a clot in or near the left frontal lobes of the brain, neurosurgeons who were not involved in Mr. McCain’s care said.

“Usually, a blood clot in this area would be a very concerning issue,” said Dr. Nrupen Baxi, an assistant professor of neurosurgery at the Albert Einstein College of Medicine in New York City.

He added, “The recovery time from a craniotomy is usually a few weeks.”

A statement from the Mayo Clinic Hospital said that the senator was recovering well and in good spirits at home, and that tissue pathology reports would come back in several days.

But many questions have been left unanswered, including whether Mr. McCain had symptoms that prompted doctors to look for the clot. In June, his somewhat confused questioning of James B. Comey, the former F.B.I. director, led to concerns about his mental status, which he later jokingly dismissed by saying he had stayed up too late watching baseball the night before.

“Usually, a blood clot like this is discovered when patients have symptoms, whether it’s a seizure or headaches or weakness or speech difficulties,” Dr. Baxi said. “Generally, it’s not found on a routine physical because doctors would not know to look for it.”

The cause of the clot has not been disclosed. The possibilities include a fall or a blow to the head, a stroke or certain brain changes associated with aging. Mr. McCain is 80.

He also has a history of melanoma, an aggressive skin cancer that can spread to the brain and cause bleeding. That cancer history could have prompted Mr. McCain’s doctors to scan his brain even in the absence of symptoms, some doctors said. The pending pathology reports are expected to help explain what caused the bleeding.

The clot could have been in one of several locations: between the skull and the dura, the membrane that covers the brain; between the dura and surface of the brain; or inside the brain itself.

Dr. David J. Langer, the chairman of neurosurgery at Lenox Hill Hospital in Manhattan, said a likely diagnosis was a subdural hematoma, a collection of blood between the dura and the brain.

“You would hope it’s a subdural, a relatively benign process,” Dr. Langer said. “It’s common in the elderly, especially if they’re on blood thinners. It can occur from relatively minor head injuries. The elderly brain loses volume, and as it retracts, the bridging veins from the brain to the dura are under increasing tension, and minor trauma can cause them to ooze or leak.”

The senator’s staff has not disclosed whether he takes a blood thinner.

Such hematomas can develop over weeks and months with subtle symptoms if they press on the brain, or even no symptoms, and removing them is usually an elective procedure, not an emergency, he said.

He said the operation is relatively straightforward. Hematomas often have an oily consistency and are easily drained once the skull is opened. The piece of skull that is removed for the procedure is then put back in place and fastened with titanium plates.

“He would be able to return to being a senator in a relatively short period of time with no ill effects,” Dr. Langer said. “This is an assumption. But it sounds like something not life-threatening or even a career-threatening problem.”

Dr. Philip E. Stieg, the chairman of neurological surgery at Weill Cornell Medicine and the neurosurgeon in chief at NewYork-Presbyterian, said it seemed a good sign that Mr. McCain was able to go home so quickly.

“I think the one possibility that’s of concern is that melanomas are known to go to the brain and they can bleed,” Dr. Stieg said. “They’ll have to wait for the pathology to come back. The good news is that five centimeters is a sizable blood clot, but in the frontal lobe, it should be well tolerated and hopefully he won’t have any neurologic deficits.”

Lawrence K. Altman contributed reporting.

https://www.nytimes.com/2017/07/16/healt...t-recovery.html


How convenient for McConnell

"an eyebrow incision would be used to reach a clot in or near the left frontal lobes of the brain"
Don't worry McCain won't notice the difference

"Glioblastoma, also known as glioblastoma multiforme (GBM), is the most aggressive cancer that begins within the brain.[5] Signs and symptoms of glioblastoma are initially non-specific. They may include headaches, personality changes, nausea, and symptoms similar to those of a stroke.[1] Worsening of symptoms is often rapid. This can progress to unconsciousness.[2]

The cause of most cases is unclear.[2] Uncommon risk factors include genetic disorders such as neurofibromatosis and Li Fraumeni syndrome and previous radiation therapy.[2][3] Glioblastomas represent 15% of brain tumors.[1] They can either start from normal brain cells or develop from an already existing low-grade astrocytoma.[6] The diagnosis is typically made by a combination of CT scan, MRI scan, and tissue biopsy.[1]

There is no clear way to prevent the disease. Typically treatment involves surgery after which chemotherapy and radiation therapy are used.[3] The medication temozolomide is frequently used as part of chemotherapy.[3][7][4] High dose steroids may be used to help reduce swelling and decrease symptoms.[1] It is unclear whether trying to remove all or simply most of the cancer is better.[8]

Despite maximum treatment, the cancer usually recurs.[3] The most common length of survival following diagnosis is 12 to 15 months with less than 3% to 5% of people surviving longer than five years.[2][3]"

https://en.wikipedia.org/wiki/Glioblastoma




What Is Glioblastoma?

If you’ve been diagnosed with glioblastoma, there are treatments to help you live better and ease your symptoms.

Where It Forms in the Brain
Glioblastoma is a type of astrocytoma, a cancer that forms from star-shaped cells in the brain called astrocytes. In adults, this cancer usually starts in the cerebrum, the largest part of your brain.

How Common Is It?
Almost 1 in 5 tumors that start in the brain are glioblastomas. Men are more likely to get them than women. And chances go up with age.

How Serious Is It?
Glioblastoma tumors are usually highly malignant, or cancerous. These are grade 4 tumors, which means they can grow fast and spread quickly.

Glioblastoma tumors make their own blood supply, which helps them grow. It's easy for them to invade normal brain tissue.

Symptoms
Because glioblastomas grow quickly, pressure on the brain usually causes the first symptoms. Depending on where the tumor is, it can cause:

Persistent headaches
Seizures
Vomiting
Trouble thinking
Changes in mood or personality
Double or blurred vision
Trouble speaking

How Tumors Become Glioblastoma
There are two types:

Primary glioblastoma is the most common. It starts out as a grade 4 tumor and is very aggressive.
Secondary glioblastoma starts as a grade 2 or 3 tumor, which grow slower. Then it becomes grade 4. About 10% of glioblastomas are this type. They tend to happen when you're 45 or younger.

Diagnosing Glioblastoma
A neurologist, a doctor who specializes in diagnosing and treating brain disorders, will give you a complete exam. It may include an MRI or CT scan and other tests, depending on your symptoms.

Treatment
The goal of glioblastoma treatment is to slow and control tumor growth and improve your quality of life. There are 4 treatments available often in combination:

Surgery is the first treatment. The surgeon tries to remove as much of the tumor as possible. In high-risk areas of the brain, the surgeon may not be able to remove all of a tumor.
Radiation is used to kill as many leftover tumor cells as possible after surgery. It can also slow the growth of tumors that can't be removed by surgery.
Chemotherapy may also be used. Temozolomide is the most common chemotherapy drug used for glioblastoma. Chemotherapy can cause short-term side effects, but it is much less toxic than it used to be.

A glioblastoma that comes back can be treated with another chemotherapy drug called carmustine (or BCNU). Small wafers containing the drug are placed in the brain where the surgeon removed the tumor.

Electric-field therapy uses electrical fields to target cells in the tumor while not hurting normal cells. It's done by putting electrodes directly on the scalp. The device is called Optune. It's given with chemotherapy after surgery and radiation. The FDA has approved it for both newly diagnosed people and people whose glioblastoma has come back.

At major cancer centers, you may also be able to get experimental treatments or oral chemotherapy, which is taken at home.

These treatments cannot cure glioblastoma, but they can put it into remission. In remission, your symptoms may let up or disappear for a time.

Glioblastomas often regrow. If yours does, it can be treated with surgery and a different form of radiation and chemotherapy.

http://www.webmd.com/cancer/brain-cancer...-glioblastoma#1