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03-OCTOBER-2012 HADIL SALEM AL-KHLEFY 11 YEARS
PILOCYTIC ASTROCYTOMA LEFT TEMPORO-OCCIPITAL LOBE WITH EPIACTIVITY.
The patient came to the clinic 01-October-2012
complaining of convulsions for 1 year starting
with tonico-clonic movement of the right upper
limb with secondary generalization. The patient
was covered with Tegretol 200 mg twice daily,
Topamax 25 mg twice daily and Lamictal 25 mg at
the evening, after what the epiactivity
decreased in intensity, but taking place 4-5
times per day , but the last month she was
seizure free. The relatives noted attacks of
fever during the last year of unknown origin.
EEG done 16-September-2012 confirmed partial
epileptic discharges in the left
temporo-occipital area. MRI of the brain done
15-September-2012 showing a cystic mass with
solid component in the left occipito-temporal
area resembling pilocytic astrocytoma.
On examination, the patient has weak right upper
limb ranging from 4/5 to -4/5. There is also
weak proximal muscles of the right lower limb
Vertical incision between the
left ear and the occipital protuberance.
Osteoplastic craniotomy done to expose the
posterior parts of the temporal lobe and lateral
parts of the left occipital lobe. The dura was
incised in T-shape to expose the lower parts
abutting the left transverse sinus. The vein of
Labbe is running in the middle of the field.
Sharp cortical incision done behind the vein of
Labbe. The tumor was directly under the cortical
incision with mild fleshy-purple color. Piece
meal removal of the tumor and fresh frozen
result was that of low grade astrocytoma. The
tumor was resected until the normal brain
structures were seen all over and the tentorium
was seen at the bottom of the field. No attempt
was done to reach the posterior horn of the left
lateral ventricle, since the medial upper wall
was looking normal healthy white matter. All
attempts were done to preserve the vein of Labbe
and its collectors from all direction. A
considerable cavity was created and the brain is
lax pulsating normal. Strict heamostasis.
Routine closure of the wound. Smooth
postoperative recovery and the patient sent to
the ICU for proper observation.
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The patient has
astrocytoma in epileptogenic area, for what the
clinical manifestations were epileptical
The hemiparesis before surgery is difficult to
interpret, because the mass is away from the
sensory-motor strip. It could be explained by
difficult venous flow by the vein of Labbe due
to tumor compression. The vein of Labbe was free
and lax with preserved all its branches at the
end of the surgery.
The final histologic result was oligoastrocytoma
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