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Responses
Hi gk.
Good to see you become active again in this site after a hiatus
My thoughts.
1.It is a GBM medulla and pons extensively involved whatever the treatment options excercised, prognosis is grave with few weeks of survival, that being the case, would do everything to stabilise/improve quality of life.
2.would go with retro sigmoid app, need to work deep between cranial nerves, between lower cranial and 7,8th complex and then between 5th and 7th too. Realistically looks like a modest decompression is all that is possible without worsening neuro status.If you could hit the cyst at the summit would be good to reduce mass effect.
3.Temporal horns are getting big, is there significant hydro?
Another development in treating GBMS in general, Avastatin(anti angiogenic) has shown good promise adding few weeks to months for new/recurrent GBMs
Best wishes
Satish Sathya
Dear GK,
I think the retrosigmoid approach is the best to reach and do whatever decompresion that is possible. Probably decompressing the cyst and taking a biopsy is all I would attempt surgically , given the location and malignant nature of the lesion.
regards,
Maqsood
I agree with Dr Satish about its dismal prognosis regardless of the histopathology and extent of surgical resection.The tumor has significant ventrally exophytic component with areas showing some sort of margin from the brain stem.I would attempt to decompress this part of the tumor as well as the necrotic/cystic component through a retrosigmoid/far lateral approach
Pramod
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