The conversation explores the risks associated with brain surgery, and why neurological deficits can occur even when procedures are performed correctly. Dr. Vigna also discusses patient anxiety surrounding neurosurgical intervention and the importance of post-operative rehabilitation in long-term recovery.
This episode also addresses emerging concerns regarding Depo-Provera and the increased scrutiny of meningiomas in patients with a history of long-term exposure. The focus of this discussion is educational and medical in nature, helping patients better understand diagnosis, treatment, and recovery considerations.
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TRANSCRIPT:
B: I'm Ben C
V: I'm Doctor V.
The Medical Legal Guys!
V: Today we're going to be giving an update on the Depo-Provera litigation.
B: A meningioma is a type of brain tumor. And it is the type of brain tumor that is caused by Depo-Provera. How do people have different results from different meningioma tumors. How does that all work? When you got somebody that doesn't have a surgery and then you've got people who have massive craniotomy surgery.
V: The decision to operate depends on size, location, symptoms and signs.
B: You could have a meningioma that's taken years to develop and is five or 6 or 7 times bigger than another meningioma that's in a different part of the brain, like you say. And you could have a smaller meningioma that will actually cause more problems than the larger meningioma.
V: True. And, you know, these are serious problems. And it's not like a knee replacement. There are places in the brain where it's more difficult surgeries. There's no real routine brains because bad things happen. Tumors will have more vascularity. They may have more bleeding during surgery. Not every brain tumor can be completely resected by all neurosurgeons. There might be just a few neurosurgeons who have the skill to provide complete removals. So this is very bad problem.
B: Not all neurosurgeons do brain surgery. So you've got a more limited number of people who even operate on the brain, right.
V: So neurosurgeons who do brain tumor work, they're often in academic centers with serious meningioma have to travel.
B: We want the best for our clients. And so, of course, the best thing is to get the best care. And the ultimate best thing would be for this to have never developed. But that's something that is beyond their control because of the lack of information and and in many respects beyond the physician's control, because through these years there was a lack of information being provided to the doctors.
V: The meningeal cell line that's in the meninges without Depo-Provera, those cells are still being replaced. Okay, because a cell doesn't live forever. Okay? And Depo-Provera will cause the cell division to be more often the more often you have cell division, you could have a mutation. Mutations happen all the time. Most mutations, they just kind of fade away. And that a mutation is when cells divide the DNA splits and then replicates.
B: And that's the problem.
V: Most mutations just go away. But then there are certain mutations that don't go away. And they become a meningeal.
B: And that's not a good thing. That's a bad thing.
V: It's a bad thing if that mutation is one that causes cancer okay. Or benign tumors. So you have different mutations. The different mutations cause different types of meningioma. And now they understand which meningioma should have radiation therapy after resection because they're more aggressive. So they could understand based on the DNA how these meningiomas behaved.
So symptoms of meningioma. So a common location is in the frontal area which is the front of the brain. Frontal tumors can affect smell. They can affect vision pressure in the brain, imbalance in coordination, cognitive problems and that could lead to, you know, the diagnosis of a meningioma and then complications from brain surgery. Those are the patients that I took care of in rehab hospitals.
And the main complication after meningioma resection is bleeding, okay. And if you bleed in the brain, that could cause neurological loss. Kind of like a stroke and swallowing problems, walking problems, significant level dependance. So these are serious injuries. You don't want a meningioma. You don't want to have to go to brain surgery. We have terrified women going for operations who can be relaxed going into a brain surgery. You know, I mean, it's terrifying.
B: Well, and we know that and I know you know it because we've talked to the same clients who have been going into brain surgery. One recent client we've had many conversations with, and it's really a tough deal because you really don't know exactly what's going to happen. And the doctor will need to inform them all. I need to inform you, Miss Smith, that you are about to undergo this procedure.
It's a serious procedure. Usually it's a lengthy, multi-hour procedure, and then all of these things can happen during the surgery. So it also can sometimes really instill fear and anxiety and worry in the patient that is undergoing it. And unfortunately, it's the truth. And unfortunately those things can occur. And not every surgery results in a 100% recovery.
V: Then you have radiation therapy and radiation therapy, 7% risk of dementia, long term of taking care of people with post radiation dementia in younger people. It is a bad deal.
B: Does every patient who undergoes meningioma have radiation therapy?
V: The goal with any resection of a meningioma is always to try getting all of it out. But there are some tumors that you can't get out because they're in a location where there is a fear that you may cause more harm than good. If you have a grade one, that you can't get all of it out, you're going to have radiation therapy.
If you have a grade two tumor and it's completely resected, that you may get a recommendation for radiation therapy. Grade three acts malignant. Generally those patients get resection plus radiation. So that's kind of the way it works. But I'm not a neurosurgeon. And those are questions that you you'll be asking your neurosurgeon. As a rehab doctor I would take care the patients who had complications.
Those two had a operation that went bad with significant neurologic deficits or who have chronic meningioma and other problems. That's kind of the field that I used to practice. If you've suffered a meningioma with Depo-Provera - Ben Martin, myself, we will look at your case individually. But we understand the seriousness of these injuries. We are litigating these cases. We have developed our own experts and we prosecuted pharmaceutical litigations.
B: For years. Every case is not a filed case. And sometimes they become unfilable because of the passage of time. It's rather important that we all remember that timing is important. And so it's important to remember these cases should be evaluated sooner rather than later. Been a pleasure today, doctor V, and forward to further discussions on Depo-Provera and the other things that we talk about.
