• HPI: A 38 year-old male, visiting from Guatemala, presents with a several month history of progressive left sided weakness. 

    PMH: non contributory 

    Physical exam 
    - Awake, alert, and appropriate 
    - CN: Left facial weakness (HB grade 3) 
    - Motor/sensory: LUE and LLE weakness (3/5) and decreased sensation to pinprick and soft touch. 
    Basic laboratory studies (CBC, Chem panel, Coagulation studies are WNL)

    Figure 1. CT scan demonstrates a large, hypodense brain stem mass with calcifications.

    Figure 2. MR-imaging demonstrates a very large mass. A distinct solid component is located ventrally and a large cystic or cavitary component located posteriorly. The solid component demonstrates contrast enhancement.

    1. Brainstem tumors are associated with a worse prognosis when:

    2. Which surgical approach would you recommend?

    3. Would lumbar drainage be safe and/or helpful in this case?

    4. Final pathology returns as an ependymoma with tanycytic features. Post-operative MR-imaging demonstrates a small residual anterior to the pons. What management paradigm would you recommend?

    5. Which of the following describes you?

    6. I practice in one of the following locations.

    7. Please add any suggestions or comments regarding this case:

    • RETRMASTOID ANTERIOR CEREBRALLAR SPLITTING ALONG fOLIA AND SPLITTING OF WHITE TRACT WILL CAUSE LEAST DAMAGE
    • Brain Stem lesions such as these deserve as radical an excision as possible followed by palliative therapy as dictated by the pathology
    • To decide about the best approach, it would be better depict all the plans, particularly here the coronal MRI.
    • Probably, suboccipital trans cerebello-medullary fissure approach would be the best choice for surgery.
    • Tumor should be approached as far lateral left as possible with a generous corticectomy of the left cerebellar hemisphere. Does the pathology qualify this mass to be referred to as a brainstorm mass? It seems to be more a ventricular mass invading the brainstem.
    • n/a
    • Would have liked to see midline sagittal and coronal MRI images to answer some of these questions!
    • Good case,uncommon.post op radiology should be included if possible.
    • Very interesting case
    • As far right lateral as possible
    • Very nice exercise
    • Since it is a bening tumor, the tumor that remains could be treat with stereotaxic radiosurgery.
    • Intrinsic brainstem lesions can rarely be of infective etiology eg tuberculomas , hydatid cyst.The retrosigmoid approach is a familiar corridor but sometimes it can be very difficult to acess the lesion esp where you have no intraop radiology or navigation.one of my cases developed bradycardia when i tried to reach the cystic component which seemed on radiology to be presenting in the Cp angle.
    • tough case
    • I want to get well training and I live in Sudan
    • Im Adrian Santana Ramirez from Mexico, and I think is very important to remove the tumor possible and avoid to damage of neurovascular structures, and after if residual tumor appear Chemotherapy and following clinical and Radiologycal evolution is mandatory. Thanks a Lot.
    • surgical approach for brain stem tumor can (should ?) be combined
    • Im Adrian Santana Ramirez from Mexico, and I think is very important to remove the tumor possible and avoid to damage of neurovascular structures, and after if residual tumor appear Chemotherapy and following clinical and Radiologycal evolution is mandatory. Thanks a Lot.
    • Are infrecuent presentación, at large of poor prognosis
    • Thanks, Need more....
    • MID LINE SUBOCCIPITAL APPROACH WITH SPLITTING OF VERMIS IS A GOOD OPTION
    • ALTHOUGH NOT GIVEN AS AN OPTION ,MIDLINE SUBOCCIPITAL APPROACH WITH SPLITTING OF VERMIS IS A GOOD APPROACH FOR THIS LESION.
    • Thanks, Need more....
    • difficult case to deal surgically
    • Double approaches can be discussed. Total removal is the best treatment to date.
    • Why dont you include Central América?

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site here. Privacy Policy