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24-NOVEMBER-2003 SU'UD HUWEISH AWWAD 15 YEARS
TUMOR OF THE LEFT MEDIOBASL TEMPORO-OCCIPITAL LOBES.
Anamnesis
The patient a Saudi citizen came to the clinic
09-July-2003 complaining of sudden onset of
headache, vomiting with convulsions since
02-July-2003. MRI done today showing tumor of
the left mediobasal temporo-occipital region.
On examination: the patient has right
hemiparesis, otherwise neurologically free. The
patient was given antiepileptic drugs. The
patient was advised for surgery
04-October-2003and MRI of the brain done the
same day showing progression of the tumor size.
At the morning of 23-November-2003 the patient
showed rapid deterioration and CT-scan
done showing bleeding inside the tumor, for what
he was urgently taken to the operating room.
Wide osteoplastic craniotomy
at the left occipito-temporal area with
reflection of the bone flap to the left ear. The
dura was opened wide to explore the most
suitable point of attack It was decided to
attack it from the most swollen gurus, through
its anterior border where bleeding took place.
The tumor was friable and it was easy to remove
the tumor mass with the bleeding sites with
preservation of vein of Labbe, which was running
at the posterolateral border draining to the
transverse sinus. Frozen section was of
malignant tumor GBM. Inspection of the wall of
the cavity for residual of the tumor was
negative and strict hemostasis was achieved and
routine closure of the wound. Smooth
postoperative recovery and the patient was sent
to the ICU for 24 hour observation.
FOLLOW UP
The patient
came to the clinic 03-December-2003 with clean wound
and the hemiparesis regressed. He was advised to
undergo radio and chemotherapy and perform MRI
before proceeding to these modalities of treatment.
Through his
uncle, the patient underwent radiotherapy at King
Faysal Hospital in Saudia. MRI done 04-December-2004
showing no recurrence. Advised to repeat MRI after 6
months.
MRI done
27-April-2005 showing a small piece of recurrence.
He was operated in Saudia 15-May-2005 and
after that got right sided paresis. MRI of the brain
done 25-August-2005 showing huge recurrence. Advice
to undergo chemotherapy. This modality of
treatment gave temporary improvement but MRI done
13-March 2006 showing wide-spread involvement
of the tumor.
Comments
The final histologic
result was glioblastoma multiforme.
Bleeding inside the tumor is a sign of
malignancy.
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