Friday, September 20, 2013

Tumour of the Brainstem ( the part that connects the brain to the spinal cord)

A 3 ½ years child suffered difficulty in walking which progressed to weakness of her right arm and leg ,slurred speech and a squint in her left eye. She was found to have a tumour of the brainstem ( the part that connects the brain to the spinal cord) and was treated with radiotherapy.

The patient improved but deteriorated again about 7 months after radiotherapy. Now she was unable to walk with marked weakness of her right limbs, nearly incoherent speech and a squint of the left eye.


MRI of brain showed a large tumour in the pons (part of the brainstem) on the left side which was bulging towards the 4th ventricle (the water channels of the brain). MR tractography was done to assess the relation of the relay tracts with the tumour which revealed their absence/ destruction in the involved area, so explaining the patient’s symptoms.

Pre-op MR Tractography

The patient’s tumour was removed by microsurgical technique and postoperative scan showed satisfactory removal of the tumour. Postoperatively she showed smooth recovery and was discharged from hospital after she started eating adequate food.
Biopsy showed the tumour to be a malignant tumour (Pontine Glioma - WHO grade III).

                     Post-operative scan

The major advantage of surgery  in patients of tumours of the brainstem is that it reduces its bulk of the tumour and allows one to know the exact nature of the tumour as well. This helps to plan future radiotherapy/ chemo-therapy on the small amount of remaining tumour more effectively thereby translating into improved results. However surgery on the brainstem is very risky as the breathing & heart control centres are there along with the control of all four limbs and the head and neck. So surgery should be done only at centres with full facilities and experienced surgeons.                                                                        

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