Diagnosis
Pilocytic astrocytoma of the left cerebral hemisphere. Status post-partial tumor resection.
Patient:
Child, 4 years old, Kazakhstan
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Expert Opinion by Prof. Martin Scholz:
The imaging clearly demonstrates a brain tumor located in the left temporal lobe. Approximately 10% to 20% of the mass was previously resected, and a significant midline shift caused by the residual tumor remains evident. This compression continues to pose a serious risk to the child's health. The histopathological diagnosis of pilocytic astrocytoma has been established.
I am highly confident that a subtotal, and under optimal intraoperative conditions, a complete (total) surgical resection can be safely accomplished. The lesion exhibits well-defined anatomical borders, which allow for precise microsurgical dissection along its tissue margins. Particular caution will be exercised when working in the medial aspects near sensitive structures.
We routinely perform these delicate procedures using intraoperative somatosensory and motor evoked potentials (neurophysiological monitoring), real-time intraoperative ultrasound, and the state-of-the-art Kinevo robotic visualization system.
We would be pleased to admit the patient and perform the required surgical intervention. Even if mild neurological deficits temporarily appear during the initial postoperative days, young children demonstrate exceptional recovery potential due to central nervous system neuroplasticity. I strongly advise proceeding with definitive surgical treatment.
Strict blood loss management is paramount during radical pediatric neurosurgical procedures. To minimize blood loss, our highly experienced pediatric neuroanesthetist, Dr. Böntgens, and I employ a combination of advanced intraoperative techniques.
Provided the child's general clinical condition remains stable prior to surgery, the prospects for a successful outcome are very high. In a similar recent case, the patient was in a significantly more compromised state preoperatively, yet tolerated the procedure well and achieved complete tumor removal. The present case offers favorable conditions due to the distinct anatomical boundaries of the mass.
Parents’ Inquiries:
- What specific methods do you utilize to control intraoperative blood loss during surgery?
Doctor's Answer:
To control blood loss effectively from the initial skin incision, we utilize sequential, step-by-step scalp clamping along the wound edges.
During tumor resection, localized bleeding within the resection cavity is controlled using specialized absorbable hemostatic matrices, such as Tabotamp or TachoSil, which ensure rapid and reliable hemostasis.
The portion of the lesion located near the basal ganglia must be dissected with extreme care. Maintaining a sufficient reserve of compatible blood products for transfusion and having a dedicated, experienced pediatric neuroanesthetist are essential components of safe care. The child's overall health status immediately prior to surgery also plays a critical role.
Preliminary Cost Estimate: €43,900
Treatment Rendered:
Following comprehensive preoperative preparation, the patient underwent osteoplastic craniotomy and complete (total) tumor resection guided by 3D neuronavigation and intraoperative neurophysiological monitoring (evoked potentials).
The postoperative course was smooth and free of complications. On the tenth postoperative day, the patient was discharged from the hospital in a satisfactory clinical condition without neurological deficits.
Actual Cost of Treatment: €37,750