Diagnosis
Brainstem glioblastoma. Status post-resection, chemotherapy, and radiation therapy.
Patient:
Male, 43 years old, Kazakhstan
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Patient’s Complaints:
One year ago, I was diagnosed with a brain glioblastoma and underwent surgical resection followed by chemoradiation therapy, as well as three additional cycles of chemotherapy with Temodal (300 mg). Following these treatments, active therapy was paused due to clinical improvement, and follow-up MRI scans showed no abnormal contrast enhancement.
Recent MRI imaging now indicates tumor recurrence. Over the past three weeks, neurological symptoms have emerged and progressively worsened: initially presenting as a left-sided limp, followed by numbness in the left arm and leg. While limb strength remains preserved, coordination is impaired; lifting the leg during walking requires noticeable effort, and fine motor skills in the hand are compromised.
Expert Opinion by Prof. Martin Scholz:
The latest MRI scans reveal a contrast-enhancing mass measuring approximately 2 cm with surrounding perifocal edema. This finding most likely represents a high-grade glioma or recurrent glioblastoma in the right periventricular region, situated in close proximity to the pyramidal tract of the brainstem, with satellite lesions located approximately 1.5 cm anterior to the primary mass. Given these anatomical findings, has the patient experienced hemibody hyperkinesia? Is the patient currently ambulatory?
In this clinical scenario, we would advise performing a stereotactic biopsy first, as surgical resection carries an extremely high risk of causing persistent hemiplegia (unilateral paralysis).
Upon the patient’s arrival at our department, it is essential to perform a Fiber-Tracking MRI (diffusion tensor imaging) to precisely delineate the spatial relationship between the tumor and the brainstem’s pyramidal tracts.
Tumors of this nature progress rapidly, making prompt therapeutic intervention critical. Following the diagnostic procedure, subsequent targeted systemic therapy or chemotherapy will be required.
Preliminary Cost Estimate: €17,100 (Stereotactic Biopsy)