Abstract:An elderly man who sought medical treatment for "apathy, poor speech and unsteady walking for 18 days" was considered to have multiple intracranial tumors after examination in the local hospital. Due to the patient's serious condition and high risk of surgery, he was transferred to our hospital for treatment. I successfully removed the patient's left cerebellar hemisphere tumor through surgery, and the patient's condition gradually improved after the operation. After pathology confirmed that it was lymphoma, he went to the Department of Internal Medicine and Radiotherapy Department of our hospital to continue to improve the follow-up radiotherapy and chemotherapy, and his condition was stable.
1. Comparison before and after surgery
At the time of admission, the patient was apathetic, slurred in speech, unresponsive, headache, nausea and vomiting, and was admitted to the room in a wheelchair. MRI of the brain: it showed multiple intracranial tumors, mainly involving the bilateral frontal lobes and the left cerebellar hemisphere, the tumor shape was irregular and the boundary was unclear, and it was patchy and annular after enhancement, and the necrotic area of the cyst was not enhancedSignificant edema is seen around the tumor. PET-CT: suggests local intestinal wall thickening of the sigmoid colon with increased FDG metabolism, and malignant lesions (colon cancer) are considered. In view of the patient's high intracranial pressure and unclear pathology, after improving the relevant examinations, we performed left cerebellar hemisphere tumor resection + dural enlargement repair + bone flap reduction and fixation for the patient under general anesthesia, and the operation went smoothly. After surgery, the symptoms of high intracranial pressure were significantly improved. Follow-up CT of the head showed complete resection of the tumor in the left cerebellar hemisphere.
2. Preoperative diagnosis
The patient has no specific medical history and has significant symptoms of intracranial pressure. MRI of the brain: it showed multiple intracranial tumors, mainly involving the bilateral frontal lobes and the left cerebellar hemisphere, the tumor shape was irregular and the boundary was unclear, and it was patchy and annular after enhancement, and the necrotic area of the cyst was not enhancedSignificant edema is seen around the tumor. PET-CT: suggests local intestinal wall thickening of the sigmoid colon with increased FDG metabolism, and malignant lesions (colon cancer) are considered. Multiple intracranial metastases are considered for preoperative diagnosis, but lymphoma cannot be excluded. Although the patient's heart disease is more serious, in order to actively clarify the diagnosis and save the patient's life, we still recommend that the patient surgically resect the tumor of the left cerebellar hemisphere to alleviate high intracranial pressure, clarify the pathological diagnosis, and prolong life.
Third, the design scheme
The patient has multiple intracranial tumors, and the diagnosis is not clear, because the colon malignant tumor cannot rule out the possibility of multiple intracranial metastatic cancers, and the imaging diagnosis is more inclined to lymphoma. The patient's intracranial pressure is very high, and if the intracranial hypertension cannot be resolved as soon as possible, it may be life-threateningWithout a clear diagnosis, follow-up positive** cannot be carried out, and the patient's survival may be greatly affected. Although the patient's heart disease is more severe, we still consider surgery to remove the tumor in the left cerebellar hemisphere first to prevent the risk of foramen magnum herniation and fully ensure the patient's life.
Fourth, the first effect
Before the operation, the patient and family were fully explained to the patient and family about the necessity of the surgery and the risks associated with the surgery, and the consent and cooperation of the patient and family were obtained. After fully improving the preoperative preparations, the left cerebellar hemisphere tumor resection + dural enlargement repair + bone flap reduction and fixation was performed under general anesthesiaDuring the operation, the intracranial pressure was high and the brain tissue bulged outward, but the operation went smoothly and took 4 hours. The patient is awake and returns to the ward. Brain CT was re-examined 4 hours after surgery, and the left cerebellar tumor was completely resected and no abnormalities were found.
FiveReview summary
After the operation, we actively gave dehydration, hormones, etc., to fully reduce the intracranial pressure, and the patient recovered smoothly: the symptoms of headache and vomiting were significantly relieved, and the mental state was improved compared with before.
Postoperative pathological confirmation was: diffuse large B-cell lymphoma, non-germinal center subtype. The patient was transferred to the Department of Internal Medicine and Radiotherapy for follow-up chemoradiotherapy. After 3 months of surgery, the patient's general condition was acceptable, and the systemic tumor control was stable.
6. Postoperative precautions
1. Manage the surgical incision after surgery to reduce the risk of local infection and even intracranial infection.
2. Lymphoma is given hormone **, which can properly control tumor tension and significantly alleviate intracranial hypertension.
3. After discharge, if you have fever, headache, nausea, vomiting and other uncomfortable symptoms, seek medical treatment in time.
4. Actively improve follow-up radiotherapy and chemotherapy to prevent tumor progression
5. Outpatient follow-up.