On December 20, 2021 I sought a second opinion from Barrow Neurological in Phoenix, Az. As noted they wanted to perform a CT Myelogram of my spine instead of the more accurate GE Fiesta-c and less invasive to me as no contrast injection is needed into my spine! They are not up to speed on their imaging techniques for this illness in my opinion.
I had already had a CT Myelogram at Tucson Medical Center so that was sent to them. Their response was:
Barrow Neurological Institute
Barrow Neurosurgical Second Opinion Program
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•The second opinion provided below is based solely on the information provided to us over the Barrow website and its subsidiaries. Barrow Neurological Institute offers no other opinion other than that contained in this document.
•Barrow Neurosurgical Second Opinion Program is strictly a second opinion program, and should not be used as a basis for a referral.
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•A second opinion is designed to convey to you a single doctor’s recommendation for treatment. Please keep in mind that it is not a substitute for a full-length evaluation or consultation, and that opinions are generally shorter than the opinions you would receive from an in-office consultation.
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•Barrow Neurological Institute is known throughout the world for providing cutting-edge treatment for people with complex neurological diseases. We perform more neurosurgical procedures than any other hospital in the United States. We also have the largest neurosurgery residency program in the country, training more neurosurgeons than any other academic medical center in the United States. We pride ourselves on being a sought after destination for patients from all over the world — many of whom have been told their condition is incurable. Barrow Neurological
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Please see next page for second opinion.
350 W.Thomas Rd. Phoenix, AZ 85013 barrowneuro.org
Phone: 602.406.3000
B arrow Neurological Institute
Barrow Neurosurgical Second Opinion Program
Patient Name: TERRY
Patient Gender: Male
Patient Date of Birth :
DICOM Study Number :
Ref. ID :
Second Opinion, completed by: Kumar Kakarla, MD
Bio Information:
https ://www.barrowneuro.org/person/kumar-kakarla-md/
Dear Mr. xxxx,
Thank you for contacting our Barrow Neurosurgical Second Opinion Program. I have had an opportunity to review your case.
Thank you for allowing us to participate in your care through the Barrow Neurological Institute (BNI)
Second Opinion program. It is our honor to be by your side in this important moment in your life. At
Barrow, we deploy all of our talent and resources to provide you with a medical opinion that is based
on decades of clinical experience and research.
Dr. Kakarla leads an interdisciplinary team of neurosurgeons, neuroradiologists, and neurosurgery residents, and this team reviewed your case. We found the following:
As you mentioned, your imaging is most significant in your thoracic spine, where there is likely an arachnoid cyst/web in the mid-thoracic region. This lesion does displace the spinal cord anteriorly, especially behind the body of T5. Otherwise, your spinal imaging is largely unremarkable, with mild degenerative findings in the cervical and lumbar spines. Based on your symptoms, this cyst could indeed be symptomatic, however further workup is needed prior to determining a treatment plan for your condition. Specifically, a CT-myelogram of your entire spine would help determine 1) whether the pathology is an arachnoid cyst or an arachnoid web and 2) if the lesion is an arachnoid cyst, whether it communicates with the spinal fluid in the remainder of the subarachnoid space or not. The only type of lesion we would recommend treating is a non-communicating arachnoid cyst, which would indeed be causing pressure on the spinal cord and result in your symptoms. In cases such as these, surgery can range from an open cyst fenestration to a cyst-peritoneal shunt placement.
350 W.Thomas Rd. Phoenix, AZ 85013 barrowneuro.org
Phone: 602.406.3000
B arrow Neurological Institute
If you would like, we would be happy to see you here as a patient and discuss possible options for treatment further. Please let us know if you have any questions moving forward. Thank you again for sending in your case and films for us to review.
Pending insurance verification and the additional studies recommended, if travel to Phoenix, AZ is an option and if you would like to be seen in consultation to further discuss this and pursue surgical treatment here at Barrow Neurological Institute, please contact Dariela or Iris at 602-406-3396 to inquire about arranging an appointment. We would be delighted to see and evaluate you and to be of help in any way possible.
Sincerely,
U. Kumar Kakarla, MD
Adult and Pediatric Spinal Deformity
Barrow Brain and Spine
James Zhou, MD
Resident Physician, Neurological Surgery
Barrow Neurological Institute
Date received complete: 12/22/2021 Date reviewed: 12/23/2021 Date completed: 12/23/2021
The Second Opinion provided through this program will be based solely on the review and evaluation of clinical information provided by the patient/physician. The Second Opinion is not a substitute for a complete medical evaluation and diagnostic workup, which should include a medical history, a physical examination and a review of all relevant medical records. The patient should discuss the Second Opinion and all other relevant medical information with the physician of his or her choice before making a treatment decision.
350 W.Thomas Rd. Phoenix, AZ 85013 barrowneuro.org
Phone: 602.406.3000