Diagnosis
Lacrimal gland mass extending into the frontotemporal region with destruction of the optic canal walls.
Patient:
Male, 68 years old, Russia
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery, Sana Hospital Duisburg
Expert Opinion by Prof. Martin Scholz:
In the area of the left eye enucleation, we observe a tumor extending from the orbit into the temporal pole (temporopolar region) up to the medial part of the temporal lobe, passing through the lateral fissure and encasing the middle cerebral artery.
The encasement of the middle cerebral artery represents the primary complexity of this surgical procedure: the artery must be carefully skeletonized and protected without sustaining vascular injury. It may be necessary to leave a subtotal tumor remnant for subsequent stereotactic radiotherapy.
Preoperatively, an additional high-resolution MRI and CT angiography are required to optimize surgical control near the middle cerebral artery. Intraoperatively, continuous vascular navigation will be performed using color Doppler ultrasound mapping to non-invasively locate and preserve the vessel.
Prior to surgery, two units of packed red blood cells will be prepared as a precautionary reserve.
The planned procedure is an extended left pterional craniotomy for tumor resection with preservation of the left middle cerebral artery, followed by skull base reconstruction, presumably utilizing a temporalis muscle flap to prevent orbital cerebrospinal fluid (CSF) leakage.
To assess the systemic extent of the disease, staging via chest and abdominal CT scans is strongly advised.
Patient’s Inquiries:
- I have currently been presented with two treatment strategies:
- Partial surgical resection followed by targeted radiation therapy for the residual tumor.
Definitive radiation therapy without surgical intervention.
My treating surgeon in Russia favors surgical resection, whereas a French medical center—which successfully treated my friend’s mother—recommends primary radiotherapy without surgery. Is it feasible in my case to forego invasive surgery and proceed solely with radiation therapy?
Doctor's Answer:
In my medical opinion, the tumor volume is too significant for primary stereotactic radiotherapy to achieve a meaningful therapeutic effect. The optimal sequence must be surgery first, followed by radiotherapy. Postoperative radiation is effective when the residual tumor volume is reduced to a few cubic millimeters; applying it at the current stage would be entirely ineffective.
Preliminary Cost Estimate: €22,930