In a much-complicated surgery, a 53 year old patient got a new lease of life after the removal of large sized tumor (35*32*34 cm), which if not removed could have led to health complications like coma, limb weakness and accumulation of fluid in the brain.
The patient, who was being treated with TB medications for a mass seen in the brain in Bihar, was admitted at the Fortis Hospital Shalimar Bagh, where the doctors performed the surgery.
The doctors at the hospital decided to remove the mass, as medication was not helpful in reducing the size of the mass. During the surgery, the doctors were surprised to discover a large mass full of blood vessels, which was covering the left side of cerebellum (which is small brain).
Despite five months of TB treatment in his hometown, there was a significant increase in the size of the mass. The patient was suffering from persistent headaches and physical imbalance. Seeing further deterioration in his health and in spite of regular medications, there was not any improvement in his health. Thus, the patient was referred to Fortis Shalimar Bagh where he consulted Dr Sonal Gupta, Director & HOD – Neurosurgery, a release said.
Dr. Gupta did a repeat MRI brain, which revealed a large mass in the brain suggestive of TB. Further diagnosis would reveal whether the tumor was malignant or non-malignant.
Dr Gupta said, “We were shocked the moment we began the surgery as we saw a large mass full of blood vessels in his brain. Without further delay, the patient was taken to the Cath lab for angiogram, which helped us understand the source of the blood supply to the tumor. His reports confirmed that he was actually suffering from a rare kind of vascular tumor, medically known as Hemangioblastoma. After detailed discussion with the neuro-intervention team, we decided to go ahead with embolization procedure, which is injecting glue like material within the tumor to reduce the blood supply. But even embolization was difficult and only 30% of blood supply could be reduced.”
He further elaborated, “It was a very challenging case for us. Repeat MRI scans and the first picture on MRI projected the patient as a case of Tuberculoma. This was a rare case of tumour in which MRI did not look like a hemangioblastomabut because it started increasing in size in the past 5 months, surgery was the only option left. We were surprised to see the large mass full of blood vessels instead of tuberculoma and had to immediate change our approach. With about only 30% of blood supply reduced with embolization, it was big challenge to remove the huge vascular tumor. However, with meticulous microscopic fine surgery, which lasted for 7 hours, the entire mass filled with blood vessels was removed without any major blood loss. After 2 days in neuro-ICU and 5 days in the ward, the patient was successfully discharged, went home walking without the support of wheel chair.”
Emangioblastoma is a benign, vascular tumor that can occur in the brain, spinal cord, and retina. This tumor accounts for about 2% of brain tumors. Even in the era of technology and advance clinical procedures, even advanced investigation modality like MRI can be misleading at times and can even lead to mortality.
Talking about the clinical excellence at Fortis Hospital Shalimar Bagh, Mahipal Singh Bhanot, Zonal Director, Fortis Shalimar Bagh said, “This was a very rare case and Fortis Hospital Shalimar Bagh was successful in carrying out the operation despite many medical challenges. With our super specialised team of neurosurgeons under Dr. Sonal Gupta, the surgery was conducted with the help of high-end neuro navigation system and Kenovo microscope.In the past too, Fortis has executed several complex surgeries and these cases represent a challenge as they are quite rare cases of brain tumor, that had remained undiagnosed for long. I am proud to say that the neurosurgery team of Fortis Hospital Shalimar Bagh is well-equipped to handle any such complicated cases with precision and intricacy with the most advanced technology and infrastructure.”
