Diagnosis
Benign tumor of the central nervous system. Presumably liponeurocytoma or schwannoma
Patient:
Female, 32 years old, Russia
Physician:
Professor Peter Vajkoczy, Chief Physician of the Department of Neurosurgery at the Charité University Hospital
Patient's questions:
I have been diagnosed with a liponeurocytoma, a benign tumour of the central nervous system. It is located in the posterior cranial fossa and involves the structures of the skull base, extending into the cervical region. The tumour is located near the cranial nerves and vital structures.
I am currently undergoing treatment in South Korea. I am receiving temozolomide chemotherapy (Temodal). Proton therapy has also been scheduled for March, as surgery is considered too risky due to the tumour's location and the associated neurological complications. The proton therapy is intended to control tumour growth and stabilise my condition.
I am currently bothered by severe headaches, which intensify when I am in an upright position. I can only spend a maximum of 10 minutes in an upright position. When I stand up, I experience a spasm in my tongue, which makes swallowing difficult. My tongue, lip and right cheek are also slightly numb.
The right side of my face, including my eye, cheek, and lip, twitches.
I have been prescribed medication, including drugs to control neurological pain, such as pregabalin. Currently, there has been no significant deterioration and my condition has stabilised somewhat, but I have not yet noticed any significant improvement. Treatment has only recently begun and its effect is being assessed. I would like to know if it is possible to remove the tumour surgically.
Response from Professor Peter Vajkoczy, neurosurgeon:
We have carefully studied the pathological examination data. Unfortunately, based on the available results, it is still impossible to definitively determine the tumour's histopathology. It is possible that it is a schwannoma after all.
Either way, we are dealing with a progressive tumour that is spreading further into the intracranial cavity in the area of the right cerebellar pontine junction. In this case, surgical removal of the tumour is necessary. This is a complex procedure that may require a stay in hospital of up to three weeks, partly in the intensive care unit.
Due to the tumour's proximity to the brainstem, postoperative disorders of the cranial nerves may occur. These could affect swallowing, speech, voice, facial muscle sensitivity and mobility, as well as hearing.
However, due to the tumour's progression, its proximity to the brain stem, the described clinical symptoms and the ambiguous pathology, there are medical indications for a repeat histopathological examination and surgical resection.