Diagnosis
Infiltrative midline tumor of the pons exhibiting astrocytic differentiation, WHO Grade IV. Status post-stereotactic biopsy.
Patient:
Child, 4 years old, Kazakhstan
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Expert Opinion by Prof. Martin Scholz:
This is an exceptionally complex tumor of the thalamus located within the left portion of the midbrain and pons, presenting with partially solid contrast enhancement and cystic components.
Regrettably, the previously performed stereotactic biopsy did not yield a definitive conclusion regarding the precise malignancy grade. If we are dealing with a WHO Grade IV neoplasm, the prognosis for recovery is unfortunately very poor. However, the lesion may alternatively represent a pilocytic astrocytoma; in pediatric patients, pilocytic astrocytomas frequently demonstrate marked contrast enhancement on MRI scans.
A viable surgical strategy involves a microsurgical procedure via a left temporal approach, aiming for maximal safe tumor resection. The portion of the mass located in the posterior cranial fossa could only be accessed and resected through a secondary approach via the left suboccipital region. This represents a highly complex and delicate neurosurgical intervention.
An additional pressing issue is the dilation of the ventricular system caused by cerebrospinal fluid accumulation. The child will soon require either a ventricular shunt placement or an endoscopic third ventriculostomy to prevent complete obstruction of cerebrospinal fluid pathways.