Brain Stem: The Final Frontier..

• June 2, 2022

The hero of the show: Yubraj.

For a parent, there could be nothing more worrying than a child getting diagnosed with a brain tumour. Seven-year-old Yubraj from Nepal was referred to us with a brainstem tumour. The child could not swallow or talk and could barely take his name. He had ataxia, had lost over 5 kgs and weighed only 14 kgs. Upon examination, it was found that he had wasting of the right side of his tongue and severe lower cranial palsy. Yubraj’s MRI showed a massive right-sided ponto-medullary tumour with hydrocephalus. The child had been to multiple doctors in Nepal and the family was feeling hopeless.  

Basis the diagnosis, he underwent right-sided subocciptial cranitomy and excision, along with VP shunt. The surgery took about 8 hours. We were fortunate that we had got a new microscope just before this case came. Along with excellent optics, it also had the use of tumour florescence which was extremely helpful in this case. The post-operation MRI showed total excision. The child was very active and was extubated the next day. He had lower cranial palsies and pooling of secretions but could be managed, and had no other motor deficits. We were all relieved, but Yubraj was not completely out of the woods. The next day, around 9 am the child suddenly became non-responsive, due to a near arrest. The child was unresponsive for about 30 mins. Tense moments for everyone but then he gradually recovered.

The next day, the child was tracheostomized, and then weaned off the ventilator. And like children usually do, he made a rapid recovery and started eating orally after just a week. Even his tracheostomy could be removed after 10 days. The child is now discharged from the hospital and making a rapid recovery. We are hopeful that he will be able to go back to his normal life very soon.

The best part - the biopsy has come back as a Pilocytic astrocytoma which is a grade 1 tumour and practically cured after total excision. Very few brain stem tumours are operable but cases like these are a lesson that not all cases are hopeless. The parents had a lot of faith in us and I am very happy to say that I was able to live up to their expectations.