A Physician’s Clinical Diary-Episode 47: A Lonely Flower in the Crevices of the Mind (1)
120 Days Fighting the Solitary Fibrous Tumour of the Dura
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[Beginning: The Opening Chapter in the Face of Destiny]
Prologue: The Weight Beneath the White Coat
Fifteen years.
That was how long I had lived with the scent of antiseptic embedded into
the fibers of my memory. The hospital air never changed its temperature, yet
human emotions constantly shifted between freezing despair and burning hope.
The surgical scalpel in my hand was no longer an instrument. It had long
ago evolved into an extension of my nervous system—sometimes even my
conscience.
People often say doctors become numb to death. They imagine we develop
armor thick enough to block grief. They are wrong.
We do not become numb.
We simply become prisoners of responsibility.
Each night, I carry my patients home—not their bodies, but their fears,
their whispered prayers, and sometimes, their final silences.
Tonight, I begin documenting my forty-seventh clinical chronicle. It is
the story of a forty-five-year-old mother who unknowingly harbored a rare brain
tumor known as Dural Solitary Fibrous Tumour (SFT). It is also the story
of the 120-day battle against a hypervascular brain tumor, and perhaps,
more importantly, the story of how fragile human resilience can bloom into
extraordinary courage.
The case would alter not only her life, but mine as well.
Cracks in an Ordinary Life
The clinic door opened with a hesitant creak.
She entered quietly, as though afraid her footsteps might disturb
something fragile. Her name was Minseo Park. Forty-five years old. Mother of
two daughters. Wife. School librarian. An ordinary life written in gentle
handwriting.
But her eyes told a different story.
They carried the weight of invisible exhaustion.
Her husband followed closely behind, clutching her medical folder with
fingers pale from tension.
“Doctor… I thought it was just menopause,” she began softly.
Her voice trembled slightly.
“I’ve been feeling dizzy… my vision blurs sometimes… and the headaches
won’t go away.”
Chronic headache is one of the most common neurological symptoms
worldwide. Often benign. Frequently stress-related. Occasionally catastrophic.
I asked carefully structured diagnostic questions—a ritual every
neurologist and neurosurgeon performs with precision:
“Does the headache worsen in the morning?”
“Yes.”
“Any nausea or vomiting?”
“Sometimes.”
“Any weakness or numbness?”
“No… just confusion… and vision fog.”
Her symptoms were subtle but alarming. Gradual neurological decline often
signals intracranial pressure elevation.
I ordered a brain MRI immediately.
The Image That Changed Everything
Later that afternoon, her MRI images materialized across my monitor like a
silent confession.
And there it was.
A sharply demarcated mass attached to the dura mater, the
protective outer membrane covering the brain. The tumor was compressing the surrounding cerebral cortex structures.
It had a distinctive radiological appearance.
Not the typical meningioma.
Something rarer.
Something more dangerous.
I invited her and her husband to sit beside me.
“Mrs. Park… I’d like you to look at this with me.”
Her husband instinctively leaned forward, gripping her hand.
“This outer layer here,” I explained, pointing at the scan, “is called the
dura mater. It protects the brain from mechanical injury. Unfortunately,
a tumor has developed on that membrane.”
Silence filled the consultation room.
Her husband finally spoke, his voice fractured.
“Is it… cancer?”
I chose my words carefully.
“The imaging characteristics strongly suggest a Dural Solitary Fibrous
Tumour (SFT). It is extremely rare. It used to be confused with
hemangiopericytoma. One of its defining features is that it is hypervascular,
meaning the tumor contains a very dense network of blood vessels.”
I paused deliberately.
“This makes surgical removal extremely challenging due to severe bleeding
risk.”
Minseo closed her eyes slowly.
“Will I die?”
Fifteen years of clinical experience never taught you how to answer that
question without feeling its weight.
“You came early,” I said gently. “That gives us a powerful advantage.
Surgery offers the best chance for survival and neurological recovery.”
The Anatomy of Fear
Over the following week, Minseo underwent comprehensive preoperative
evaluations: cerebral angiography, vascular mapping, and neurological baseline
testing.
Each test revealed new medical insights—and new emotional fractures.
During cerebral angiography, contrast dye illuminated the tumor’s
aggressive blood supply like glowing roots spreading through fertile soil.
Hypervascular brain tumors like Dural Solitary Fibrous Tumours are
notorious for intraoperative hemorrhage. Their feeding arteries often originate
from the external carotid circulation, occasionally intertwining with cortical
vessels.
I explained the findings during our surgical counseling session.
“This tumor behaves differently from common brain tumors. Its blood supply
is intense. Removing it requires delicate dissection and constant bleeding
control.”
Her husband asked quietly,
“What happens if bleeding can’t be controlled?”
I answered honestly. Honesty is a physician’s most dangerous yet necessary
instrument.
“There is a risk of stroke, neurological damage, or even death.”
Minseo inhaled deeply.
Then she surprised me.
“Doctor… I want to live long enough to see my daughters graduate.”
Her voice did not tremble.
In that moment, she stopped being a patient and became a warrior.
Preparing for the Storm
Preoperative embolization was considered—a technique sometimes used to
reduce tumor blood flow. However, due to the tumor’s proximity to functional
cortical vessels, the procedure carried a stroke risk.
After a multidisciplinary tumor board discussion, we decided against
embolization.
Surgery would be our battlefield.
The night before surgery, I visited her hospital room.
She sat by the window watching city lights flicker like distant
constellations.
“Are you afraid?” I asked quietly.
“Yes,” she admitted.
“Me too,” I replied.
She looked at me with surprise.
“Doctors get scared?”
“All the time,” I said. “Fear keeps our hands precise.”
She smiled faintly.
Then she whispered,
“If something happens to me… please tell my daughters I tried to stay
strong.”
I felt something tighten in my chest.
“You will tell them yourself,” I said firmly.
The Surgical Dawn
Brain tumor surgery always begins before sunrise.
The hospital corridor glowed under sterile fluorescent lights. The operating
room hummed with mechanical anticipation.
Minseo lay on the transport stretcher, clutching a small photograph of her
family.
I placed my hand over hers.
“I promise to fight for you.”
As anesthesia induced unconsciousness, monitors synchronized into rhythmic
mechanical music: heart rate, oxygen saturation, and intracranial pressure
monitoring.
The craniotomy began.
Bone flap removal exposed the dura mater—the fortress protecting her
brain.
And beneath it waited the enemy.
First Encounter with the Red Empire
The dura was incised carefully.
The tumor emerged immediately—dark red, firm, vascular, pulsating with
life stolen from its host.
Exactly as textbooks described, Solitary Fibrous Tumour of the Dura.
But textbooks never describe the emotional gravity of confronting
something alive inside another human being.
“Prepare bipolar cautery,” I instructed calmly.
The moment we touched the tumor surface, bleeding erupted.
Hypervascular tumors behave like wounded animals.
Blood flooded the surgical field.
“Suction!”
My assistant cleared the field repeatedly while I identified feeding
vessels one by one.
This process is called devascularization—the strategic shutdown of
the tumor’s blood supply before mass removal. It is the most critical step in
SFT neurosurgery.
Millimeter precision determined survival.
Hours passed unnoticed.
Inside the microscope, time loses meaning.
Conversations in the Operating Silence
During the fifth hour, one of the junior residents whispered nervously,
“Professor… blood pressure is dropping.”
Anesthesia adjusted fluids and vasopressors rapidly.
I continued dissecting.
“Stay focused,” I said quietly. “The brain listens to panic.”
Neurosurgery requires absolute emotional neutrality. Even the surgeon’s
breathing rhythm affects hand tremor amplitude.
Eventually, the main feeding artery was isolated and cauterized.
The bleeding slowed dramatically.
The tumor began separating from the cortical surface.
Like uprooting a parasitic tree.
The Moment of Extraction
Eight hours after incision, the final tumor attachment was severed.
The entire mass lifted free.
The operating room fell silent.
I placed the tumor specimen into a sterile container for histopathological
analysis, the definitive diagnostic confirmation for Dural Solitary Fibrous
Tumour using markers such as CD34 positivity and mitotic index
evaluation.
“Gross total resection achieved,” I announced quietly.
Relief washed through the room.
But neurosurgeons never celebrate early.
The brain still needed protection from postoperative swelling, hemorrhage,
and neurological deficit.
We closed carefully.
Layer by layer.
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