Diagnosis
Cerebellar tumor. Secondary internal hydrocephalus. Postoperative condition following brain shunt placement.
Patient:
Child, 7 years old, Kazakhstan
Physician:
Professor Martin Scholz, Chief Physician at the Duisburg Neurosurgery Clinic
Patient's History:
The patient was born in 2015 via emergency C-section due to fetal distress. He spent three weeks in the neonatal intensive care unit. After discharge, he was placed under the care of a neurologist. At 1.5 months of age, an ultrasound of his head was performed, revealing increased intracranial pressure. After taking prescribed medications, the pressure normalized. At three months, a repeat brain ultrasound was performed. He was cleared for vaccinations! Additional ultrasound examinations were conducted at 5 and 11 months.
The child continued to develop appropriately for his age. At 3.5 years old, he started attending a regular preschool. Nothing was troubling him. At age six, he started regular school, and there were no complaints. However, in early August 2022, he began vomiting and had a fever. We consulted with doctors, and he underwent examinations by a gastroenterologist, including an abdominal ultrasound and a breath test for Helicobacter. We began treatment with a gastroenterologist. However, there was no improvement. The child experienced severe weakness, headaches, and vomiting every two to three days in the mornings. He became very weak, with an unsteady gait, and was literally staggering.
In October 2022, he was admitted to the neurology department. Based on the results of a brain CT scan, we diagnosed a cerebellar tumor. Surgery to place a cerebral shunt was performed on the same day. He was then transferred to the neurosurgery department. The tumor was not removed.
Response from neurosurgeon Professor Martin Scholz:
The child has a large tumor in the cerebellum, primarily on the right side, that can be successfully removed. In my opinion, it is either an astrocytoma or a medulloblastoma. There is no reduction in ventricle size or evidence of a shunt on the postoperative MRI images. However, if the child’s condition has improved, then the shunt is functioning properly.
The child should undergo surgery as soon as possible.
We recommend performing a suboccipital craniotomy. We also recommend performing tumor resection in the sitting position.
Estimated cost of treatment: €34,000
Treatment performed:
A total resection of the cerebellar tumor was performed via suboccipital craniotomy. Histological analysis of the resected tumor tissue corresponds to a grade I astrocytoma, according to the WHO classification.
The child was monitored in the pediatric intensive care unit after the surgery. Postoperative MRI scans revealed voluminous cysts and significant dilation of the fourth ventricle. This led to the decision to perform an urgent shunt occlusion procedure, which was completed successfully on the same day. The child remained under observation in the PICU after the surgery. His condition improved significantly in the following days. He received enteral nutrition and intravenous fluids. Follow-up CT scans showed a reduction in the size of the hydrocephalus.
Three days after surgery, he was transferred to a regular ward in the pediatric neurosurgery department, where he underwent initial rehabilitation under the supervision of a physical therapist. A cervical brace was used as an assistive device. The dressings were changed regularly, and it was noted that the wound was always dry and free of irritation. The sutures were removed ten days after surgery, and the child was discharged from the clinic.
Recommendations:
We recommend a follow-up CT scan one week after discharge and an MRI with a contrast agent in three months.