Meet Lenore, My Radiosurgeon

On June 3rd, I had brain surgery to treat a benign tumor called a meningioma. I knew ahead of time that the surgeon wouldn’t be able to remove the entire tumor – its geography extended from my cavernous sinus to the pituitary gland to the left hemisphere of the brain and to my brain stem.

The surgery helped preserve the sight in my left eye, cull the tumor and may protect my quality of life for the future. But I also needed highly targeted radiation therapy, also known as radiosurgery, to attempt to mutate the tumor’s DNA to stop its growth.

After getting your skull sawed open, the prospect of radiation treatment can seem anticlimactic, but it’s not simple or easy or risk-free. Fortunately, I was in good hands. Let me introduce you to Lenore, one of the key members of my radiosurgery team.

After my first post-op MRI, Lenore was ready to get to work right away. I was scheduled for a CT scan and five subsequent radiosurgery sessions.

The MRI and CT imaging are used to target the radiation, and the precision of radiosurgery requires assistance in keeping your head stationary. To this end, the radiosurgery specialists made a mask for my face, which would be affixed to the treatment table while Lenore was at work.

The mask began as a flat plastic grid which they heated in warm water while I got used to the room, a fairly calm environment with relaxing music and starlight projected on the ceiling.

Having had anxiety with the enclosed spaces of MRIs, I wasn’t sure how it would feel to have my face stuck to a table while receiving radiation. But I felt pretty calm as they slowly pressed the warm plastic grid over my face and stretched it into a three dimensional mask.

Then they took me to the basement to the CT scanner. I’d had several CT scans after surgery and they’re short compared to MRIs so I expected it to go smoothly. But this scanner seemed smaller than the others and my head was enclosed in the mask which was attached to a small block behind it. As soon as the doctor and technicians left the room and prepared to start the test, my anxiety redlined. After two failed attempts, they asked me to step out so they could scan other patients.

I waited in the hallway searching for the meditation skills I’d learned in yoga. It helped when one of the technicians came out to acknowledge that I’d had a hard year. And, embarrassingly, it helped when I thought of one of my two cats that I’d had to put to sleep the year before at 19. Having him in mind was surprisingly comforting. Finally, before the technicians started the scan, I asked if one of them could hold my hand for ten seconds. They paused and then one of them did. And that was all that I needed to know that I could trust this person to run me through the machine while wrapped within the mask. Still, I felt a bit ashamed for having asked – it took some time to realize how human a request this was.

Within a few more days, I came for my first radiation treatment. One of the technicians shared a copy of the treatment map with me. The lines in the upper left indicate all of the directions that Lenore would send radiation at me. The colored contour maps in the other boxes showed the boundaries of the radiation treatment based on the intensity of each beam.

Using the imaging, Lenore would be guided to treat the boundaries of my tumor as closely as possible, leaving healthy tissue less affected. (You can read more about radiosurgeons like Lenore at the CyberKnife FAQ.)

To pace the effects of the radiation on the body, my treatments were broken into five sessions. The exact length of the sessions isn’t known until Lenore reviews the prescribed sequencing with me on table. It turned out they were each 27 minutes.

The following images are from the end of my second or third session. That’s the treatment room. I’m on the table with my face in the mask, affixed to the table. Lenore’s in the background to the right. Small X-ray machines on the ceiling helped the specialists ensure the precise positioning of my head throughout treatment.

The mask’s attachments do allow you to sit up and stop the treatment at any time but it disrupts the process and requires additional positioning X-rays to restart Lenore.

Before Lenore can go to work, the staff leaves and presses a button which closes the steel radiation door:

This is what Lenore looks like as she moves around you to target the radiation beams. Her eye is a lens which can open and close to adjust the intensity of individual beams.

As Lenore’s body moves around in three dimensions, she makes the sounds of heavy machinery and a slight buzz as her beam is activated for a few seconds. Some of the beams may pass through optical nerves which trigger the appearance of bright blue light within the eye.

Certainly, this process didn’t trigger the same fear as the craniotomy did for me. But the MRI, the CT scan, being attached to a table in a mask in a closed room for nearly two and a half hours of radiation – radiosurgery challenged me psychologically, in some ways more intensely than my craniotomy.

One of the most difficult initial moments for me was after they closed the door and informed that they had paged the doctor to review the positioning. No one had told me that I might need to be stuck to the table for an unknown amount of time before Lenore could even start.

The oncologist and the staff that managed the treatments helped me through all of this. From the CT technician that held my hand for a moment, to the team that greeted me every day with compassion and kindness – their support helped me through a pretty tough week. When I told them the most uncomfortable time for me was on the table waiting for the treatment to begin, one of them would sit beside me until the last possible moment.

Still, despite all my questions and reviews with doctors, I felt a bit of doubt about whether I was pursuing the right form of treatment. I could feel the radiation. It was subtle, but it was real, and I wondered what damage it might inadvertently cause. And after several days, I asked to meet with the oncologist again to assure me I was doing the right thing. He walked me through the treatment map again and helped me feel clearly we were following the right path.

And my girlfriend helped too. She came with me to the MRI and after I struggled with the CT scan, she insisted on taking me to all five radiation sessions. It was reassuring to have her there waiting outside for me each day.

Here’s a post-treatment selfie, and my girlfriend surprising me with flowers:

And, you get to take home the mask for Halloween: