A right handed 49 year old female came complaining of a chronic, more than 7 years, episodic headache affecting only the left side of the head and face. The headache is of throbbing quality accompanied by nausea and precipitated by stress and alcohol ingestion. She came because of worsening in terms of frequency, duration and strength of headache episodes. She also noticed occasionally some difficulty in reading, writing usual paperwork and calculating but explained these as a result of overwork and stress claming being well when not tired. Sometimes she even could not tape a simple phone number without bigger effort and concentration. In the past she was seen by another neurologist but, for irrelevant reasons, never followed his advice to perform an imaging study of her brain.
CT & MRI revealed a probably benign but quite big tumor localized deeply in the left parietotemporooccipital region of the dominant hemisphere with sharp margins, small surrounding edema and seemingly deriving from the occipital horn of the left cerebral ventricle. MRI of the entire rest of CNS (neuraxis), made to exclude other seeding sites, was clear.
How would you treat this patient? Surgery, radiation, chemotherapy, just watch for a while?
couple of neurosurgeons consulted suggested approximately
a 10% risk of permanent neurological sequel in case of surgical removal.
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(c) 2007 M.H. Rivner