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24-NOVEMBER-1999  ABDEL-RAZAQ IHAB AL-RAYYAN  6 YEARS  HUGE MEDULLOBLASTOMA VERMIAN ORIGIN
Patient's name: Abdel-Razaq Ihab Al-Rayyan File number: MB
Age: 6 years
Date: 02.12.1999
Address: Amman. Abu-Nsseir. Section :4. Al-Faruji street. Tel.: 5237667 Diagnosis :. Vermian giant medulloblastoma classic type

This is to certify, that the above mentioned patient was admitted to the hospital 23.11.l999 complaining of vomiting and inability to walk or set down. The patient was lethargic with ability to move all limbs upon verbal request. MRI was performed and showed huge medulloblastoma occupying the posterior fossa. The patient had a previous picture of breathing disturbances 6 days prior to admission. Neurologically there was severe cerebellar signs with horizontal nystagmus when looking to the sides. The vital signs were acceptable and the breathing pattern is normal. The patient was observed for any disturbances of the vital signs for several hours and then was taken to the operation room. Suboccipital approach was used with the patient  patient in the sitting position. A suboccipital osteoplastic craniotomy with the bone flap still attached to the  ligamentum flavum reflected down to the neck was performed . Piece meal resection  of highly vascular tumor was performed. The tumor was kissing the floor of the 4th  ventricle , but radical removal of the tumor was achieved. Postoperative recovery was acceptable  and there was  right sided hemiplegia. The hemiplegia started to resolve and the patient was able to walk the 3d postoperative day. Stitches removed the 7th postoperative day.

Immediate postoperative and the 4th postoperative day brain CT-scan were performed and showed the radical removal of the tumor. Fever was noted all the time and the wound was clean and dry. The hydrocephalus slightly  regressed and the air in the

    frontal horns was noted in the investigations. No meningismus. The histopathology results were those of medulloblastoma classic type with immunohistochemical analysis confirming the result. The exam showed cellular small cell tumor with strong positivity for synaptophysin. It was negative for cytokeratin, OF AP and NSE. The patient is sent home  the 7th postoperative day. Recommended to continue physiotherapy and to undergo radiotherapy 2 weeks later. Repeat MRI    recommended after three months

 


Preoperative MRI showing the medulloblastoma and immediate postoperative CT-scan showing the radical resection of the tumor.

The patient then came 01-August-2006 with new MRI after receiving course of growth hormone therapy with minimal changes in the periphery of the resected tumor holding suspicion about recurrence. It was advised to stop growth hormone therapy , since it could provoke regrowth, even the dormant resected tumor and sent for PET studies.

Please for theoretical data concerning medulloblastomas click here!

 


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