The first successful Brain tumor surgery at Wallaga University Comprehensive Specialized Hospital (WUCSH)
Clinical Synopsis: A 40-year-old right-handed male presented with a three-month history of progressive dysarthria and right-sided hemiparesis. His neurological status precipitously declined, culminating in a comatose state (Glasgow Coma Scale [GCS] of 6) upon admission and Rt side hemiplegia.
A subsequent head computed tomography (CT), followed by contrast-enhanced CT, revealed a substantial left frontoparietal heterogeneously enhancing extra-axial mass, complicated by subfalcine herniation and significant perilesional edema.
After initiating him on dexamethasone (10mg loading dose, followed by 8mg three times daily) and phenytoin (loading dose, followed by maintenance), the patient demonstrated a marked neurological improvement, with his GCS rising to 12/15.
Due to financial constraints and social reasons precluding transfer to Addis Ababa for further study and intervention, the family implored us to exhaust all available resources within our institution's capabilities.
Intervention and Outcome: A left frontoparietal craniotomy was performed, achieving a Simpson Grade I resection, encompassing an en bloc removal of the tumor with the involved overlying dura and subsequent pericranial duraplasty.
Postoperatively: The patient exhibited a remarkable recovery, attaining a GCS of 15/15 and demonstrating improved motor strength (4+/5) by the second postoperative day.
Subsequent plan: Collect Bx result and possibly RT based on the grade of tumor.
Key Takeaway: This case underscores that, even amidst a dearth of microsurgical infrastructure, meaningful interventions and significant improvements in patient outcomes remain within reach. It's a testament to the fact that where there's a will, there's a way, and that we can still move mountains, even with limited resources.
Technical Nuances: During en bloc tumor resection, persistent oozing from the tumor bed was encountered. In resource-constrained environments such as ours, adhering to the "5 Ds" of meningioma surgery (particularly debulking) proves invaluable, conserving both time and effort. This allows us to cut to the chase and prioritize the most effective steps.
Acknowledgements: Profound gratitude is extended to the anesthesia, nursing, and intensive care unit teams for their unwavering dedication and collaborative spirit.
Neurosurgical Team:
• Dr. Kedir Dekebi, Neurosurgeon
• Dr. Gadisa, Senior GSR
• Dr. Saber, Senior GSR
• Dr. Oli, GSR
• Anesthesia Team: Mr Nega & Gebisa
•Scrub nurse Mr. Geleta
•Circulator nurse Mr. Latera
[Consent obtained for the use of pictures and medical history]
@HakimEthio
Clinical Synopsis: A 40-year-old right-handed male presented with a three-month history of progressive dysarthria and right-sided hemiparesis. His neurological status precipitously declined, culminating in a comatose state (Glasgow Coma Scale [GCS] of 6) upon admission and Rt side hemiplegia.
A subsequent head computed tomography (CT), followed by contrast-enhanced CT, revealed a substantial left frontoparietal heterogeneously enhancing extra-axial mass, complicated by subfalcine herniation and significant perilesional edema.
After initiating him on dexamethasone (10mg loading dose, followed by 8mg three times daily) and phenytoin (loading dose, followed by maintenance), the patient demonstrated a marked neurological improvement, with his GCS rising to 12/15.
Due to financial constraints and social reasons precluding transfer to Addis Ababa for further study and intervention, the family implored us to exhaust all available resources within our institution's capabilities.
Intervention and Outcome: A left frontoparietal craniotomy was performed, achieving a Simpson Grade I resection, encompassing an en bloc removal of the tumor with the involved overlying dura and subsequent pericranial duraplasty.
Postoperatively: The patient exhibited a remarkable recovery, attaining a GCS of 15/15 and demonstrating improved motor strength (4+/5) by the second postoperative day.
Subsequent plan: Collect Bx result and possibly RT based on the grade of tumor.
Key Takeaway: This case underscores that, even amidst a dearth of microsurgical infrastructure, meaningful interventions and significant improvements in patient outcomes remain within reach. It's a testament to the fact that where there's a will, there's a way, and that we can still move mountains, even with limited resources.
Technical Nuances: During en bloc tumor resection, persistent oozing from the tumor bed was encountered. In resource-constrained environments such as ours, adhering to the "5 Ds" of meningioma surgery (particularly debulking) proves invaluable, conserving both time and effort. This allows us to cut to the chase and prioritize the most effective steps.
Acknowledgements: Profound gratitude is extended to the anesthesia, nursing, and intensive care unit teams for their unwavering dedication and collaborative spirit.
Neurosurgical Team:
• Dr. Kedir Dekebi, Neurosurgeon
• Dr. Gadisa, Senior GSR
• Dr. Saber, Senior GSR
• Dr. Oli, GSR
• Anesthesia Team: Mr Nega & Gebisa
•Scrub nurse Mr. Geleta
•Circulator nurse Mr. Latera
[Consent obtained for the use of pictures and medical history]
@HakimEthio