Diagnosis
Brainstem tumor with a cystic component. Status post-partial tumor resection.
Patient:
Child, 5 years old, Belarus
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Expert Opinion by Prof. Martin Scholz:
Following a detailed multidisciplinary review of the MRI scans with our colleagues from the Pediatric Oncology Department, we suspect we may be dealing with a pilocytic astrocytoma infiltrating the brainstem. While a complete tumor resection is not anatomically achievable, we can safely perform a partial debulking under continuous intraoperative neurophysiological monitoring. This will allow us to obtain adequate tissue samples for advanced molecular genetic testing, including IDH mutation status, DNA methylation profiling, and other diagnostic markers.
At Düsseldorf University Hospital, it is also possible to conduct cell culture testing on the tissue specimen to evaluate chemosensitivity. However, please note that this remains an experimental and high-cost approach.
Prior to surgery, a transesophageal echocardiogram (TEE) will be performed to rule out a patent foramen ovale (PFO), as we plan to carry out the surgical intervention in a seated position.
Opinion by Dr. Höll, Head of Pediatric Oncology:
Because the tissue sample obtained during the initial procedure did not provide conclusive diagnostic information regarding the specific cell type, a repeat procedure is necessary to collect sufficient tissue for comprehensive histopathological analysis. Without a definitive histological diagnosis, a tailored subsequent treatment strategy cannot be established. As Prof. Scholz noted, complete surgical removal is not feasible. The post-biopsy findings will guide and dictate all further treatment recommendations.
Parents’ Inquiries:
- What potential risks or complications are associated with this surgery?
Doctor's Answer by Prof. Martin Scholz:
This is a highly complex neurosurgical intervention. Statistically, overall complication rates in comparable clinical scenarios range from 7% to 10%. Potential risks include hemorrhage, infection, cranial nerve dysfunction, hemiparesis (unilateral weakness), among others. The statistical mortality risk is approximately 1%, as documented in current scientific literature. However, by utilizing real-time intraoperative neurophysiological monitoring, we are able to significantly reduce these risks.
Preliminary Cost Estimate: €30,000
Treatment Rendered:
The patient underwent suboccipital midline craniotomy and microsurgical brainstem tumor resection guided by 3D computer neuronavigation. The procedure presented heightened surgical complexity due to extensive postoperative scarring from the prior operation and mild local edema, which caused increased intraoperative bleeding. Despite these challenges, the surgery was completed without complications.
Definitive histopathological analysis revealed no malignant tumor cells. The evaluated tissue represented reactive gliotic cerebellar tissue showing no evidence of active neoplastic process. Consequently, no additional oncological treatment is required at this time.
On the 11th postoperative day, the patient was discharged from the hospital in good clinical condition.
Actual Cost of Treatment: €25,484