Abstract:An elderly woman who sought medical treatment for "lung adenocarcinoma with multiple systemic metastases targeted ** for 1 and a half years, headache for 2 months, and unresponsiveness with unfavorable limb movement for more than half a month" was found to have a brain tumor with large cerebral edema after examination. Due to the location of the tumor and the high risk of surgery, he was transferred to our hospital for treatment. I successfully removed the patient's brain tumor through surgery, combined with drugs** to alleviate the patient's intracranial hypertension and neurological dysfunction, the patient's headache was relieved, and the limb function was significantly improved.
1. Comparison before and after surgery
The patient had lung adenocarcinoma with multiple systemic metastases targeting ** for 1 and a half years, headache for 2 months, unresponsiveness and unfavorable limb movement for more than half a month. At the time of admission, the patient had obvious headache, nausea and vomiting, poor spirit, and slow responseIncreased muscle tone on the left side, muscle strength levels in the left limb. MRI of the brain: showed a tumor of the right frontal lobe-corpus callosum, obvious edema of the right frontal insular lobe-corpus callosum, compression and deformation of both ventricles, and a shift to the left of the midline structure. After completing the relevant examinations, we performed right frontal lobe-corpus callosum tumor resection + bone flap reduction and fixation for the patient under general anesthesia, and the operation went smoothly. After the operation, mannitol was actively administered to dehydrate, and the patient's cerebral edema and intracranial hypertension gradually improved, the headache was relieved, and the muscle strength of the left limb gradually improved. Follow-up MRI of the brain: the tumor was completely resected, the edema improved, and no tumor was found**.
2. Preoperative diagnosis
The patient's lung adenocarcinoma was targeted**, and the medical history was clear;Intracranial symptoms such as headache, nausea and vomiting, and limb dysfunction are obvious. MRI of the brain: showed a tumor of the right frontal lobe-corpus callosum, obvious edema of the right frontal insular lobe-corpus callosum, compression and deformation of both ventricles, and a shift to the left of the midline structure. Based on the history and clinical symptoms, combined with the results of MRI of the brain, the diagnosis is considered to be brain metastases. After admission, routine preoperative examinations such as blood routine, biochemistry, coagulation, and electrocardiogram were improved, and no obvious abnormalities were found, and contraindications to surgery were ruled out. The patient has obvious tumor occupancy and severe neurological impairment, so aggressive surgery is recommended.
Third, the design scheme
For the patient's right frontal lobe-corpus callosum tumor, craniotomy via longitudinal fissure approach is the preferred option. The preoperative diagnosis of the patient is metastatic cancer, and the key to surgery is to completely remove the tumor during the operation and try to achieve the "tumor-free principle". In addition, the location of the tumor is deep and closely related to the anterior cerebral artery and its branches, and the translongitudinal fissure approach requires traction of the parasagittal sinus cortical vein, which is essential for the protection of the cortical vein and artery during surgery.
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 right frontal lobe-corpus callosum tumor resection + bone flap reduction and fixation was performed under general anesthesia, and the operation was smooth and took 3 hours. The patient is awake and returns to the ward. Brain CT was re-examined 4 hours after surgery: the tumor was completely resected and no abnormalities were found.
After aggressive postoperative medication**, the patient recovered well, his headache was relieved, and his body temperature was normal. Liquid eating was resumed on the 2nd day after surgery, left limb strength began to improve on the 4th day, and on the 7th day, he could get out of bed and stand up with the assistance of others and move for a short time.
FiveReview summary
Postoperative pathological results suggested: brain metastases of lung adenocarcinoma. The patient's postoperative genetic testing showed that there was a specific gene mutation, and the targeted drug was matchedContinue to change targeted medications**. Follow-up MRI of the head after 3 months: no tumor was found**.
6. Postoperative precautions
1. Do a good job of surgical incision management after surgery to reduce the risk of infection.
2. Wear elastic stockings after surgery, and actively and passively move to prevent deep vein thrombosis of the lower limbs.
3. After discharge, if you have fever, headache, nausea, vomiting and other uncomfortable symptoms, seek medical treatment in time.
4. The Department of Internal Medicine continues to improve the follow-up.
Follow-up at the clinic after a month.