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The following clinical profiles provide detail about Callie, Alex, Jake and Sam (recent patients) and the care they received from the neurosurgeons and staff within the Pediatric Neurosurgical Service.
Callie. Callie presented at age four with a several day history of increasing headache, nausea and drowsiness. An ACT scan showed severe hydrocephalus secondary to a pineal gland tumor. An emergency shunt operation was done to relieve the raised intracranial pressure. The following week her benign pineal tumor was successfully removed in a six-hour operation. She has since then remained a normal, energetic child with no evidence of further difficulty on careful follow-up.
Jake. Jake presented at age seven with severe, intractable seizures. He had a congenital left hemiparesis likely as
the result of some perinatal/intrauterine insult. This left him with little or no useful movement of the left hand or arm, a weak left leg and a left homonymous hemianopsia. Nevertheless, he was able to run, attend school, play with his friends, etc.
Video/EEG monitoring captured numerous seizures with a presumed right sided onset but these were poorly localized. MRI demonstrated a large porencephalic cyst and gliosis throughout the right hemisphere.
Jake had a large subdural grid of subdural electrodes implanted into his head over the right hemisphere to more accurately determine where the seizures began. The invasive EEG studies demonstrated seizure onset from the scarred cortex surrounding the cyst. We therefore performed a right functional hemispherectomy. He has done extremely well since surgery with no new neurological deficits. He has remained seizure-free and is back at school and sports. He recently graduated from third grade with improved grades and is active in tennis, swimming and soccer.
Alex. Alex presented at age eight with three
months of progressively intense nausea
and vomiting. Evaluation by blood test, abdominal CT and endoscopy of his
gastrointestinal tract showed
no abnormality. However when he
developed headaches his doctors ordered a head CT scan, followed by an MRI. These studies showed a large tumor in the IVth ventricle, causing compression on neurological vomiting centers of the brainstem. His doctors then referred him to the Pediatric Neurooncology Center at MassGeneral Hospital for Children.
Sam. Sam presented at age 16 with vomiting for two weeks. He was admitted to North Shore Children’s Hospital where his pediatrician realized that this was something more than the usual gastrointestinal illness. A CT scan revealed a tumor in the back part of his brain (cerebellum) that would require surgery. He was transferred to the MassGeneral Hospital for Children where multiple MR scans showed that this was his only tumor. The next day he underwent eight hours of surgery. There was no visible tumor at the end of the surgery and none on the MR scan that was performed the next day. He was discharged five days following surgery and returned to school within the week. Unfortunately, the pathologic/microscopic examination of the tumor showed that it is a type that has a high risk of recurrence so that additional radiation therapy and chemotherapy will be needed to reduce his risk of recurrence.
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