- State-of-the-art medical technologies were used for neurosurgery, such as a surgical microscope, neuronavigator and trans-surgical ultrasound.
- The operation lasted five hours and the patient was kept awake to monitor the functions of her central nervous system and preserve them.
- During the last 22 years, it is the first time that a case of this type has been reported in the ISSSTE.
The general director of the Institute of Security and Social Services for State Workers (Issste), Pedro Zenteno Santaella, recognized the work of neurosurgeons and a multidisciplinary health group from the National Medical Center (CMN) “20 de Noviembre”. Thanks to the collaboration of all, it was possible to extract a extremely rare malignant brain tumor which was the size of an egg to a 34-year-old female beneficiary. To achieve this, a complex and successful highly specialized surgery was required.
Description of the medical case
The leading surgeon of the procedure and member of the Mexican Society of Neurological Surgery and the Medical Society of the CMN “November 20”, Cuauhtémoc Gil-Ortiz Mejía, highlighted that the intervention was carried out on March 22 last. The results were classified as very favorable.
For her part, the patient presented a high-risk clinical picture that, in three months, underwent three surgeries. First of gallbladder, after open heart to remove malignant and brain tumor, and finally to remove the tumor metastasis.
“The neurosurgery was quite successful because the patient’s language, memory, or mathematical calculation faculties were not affected. In fact, she has recovered some abilities that were altered before being operated on, due to the tumor”.
Neurosurgeon Antonio López López and resident doctors Cristóbal Rubén Villavicencio Nava, César Hernández Zamora and Diego Galarza Alcocer also participated in the procedure. Also the anesthesiologist Hermenegildo Cortés Rivera and the specialist nurses Georgina Hernández Chico and Adriana Torres Campos.
Gil-Ortiz explained that the tumor was located on the left side in the deep area of the brain and was a metastasis of leiomyosarcoma-type cancer developed in the heart.
The brain operation lasted five hours and the patient was kept awake to monitor and preserve her central nervous system functions. During that period, questions related to names, dates, addition or subtraction in sequence, and instructions on how to move different parts of the body were asked.
The tumor compromised structures related to language, comprehension, calculation and visual function. Sedation and local anesthesia were applied so as not to cause additional damage and to verify that sensitivity was not altered throughout the body.
It is a fortuitous diagnostic finding, said the Issste specialist, who also belongs to the Mexican Society of Spine Surgery and the Inter-American Society of Minimally Invasive Spine Surgery.
An extremely rare giant brain tumor
He reported that the patient was first operated on a gallbladder at the General Hospital “Dr. Fernando Quiroz Gutierrez. Subsequently, on February 8 at the CMN “20 de Noviembre” she was subjected to a open heart procedure to remove a tumor.
“A pathological study of the tumor confirmed that it was leiomyosarcoma-type cancer, considered one of the most aggressive in existence. Its presence is extremely rare in the heart and even more so that it metastasizes to the brain. In 22 years that I have been working at the CMN, ’20 de Noviembre’ is the first report of a case like this”.
He reported that during her hospitalization for cardiac surgery, the patient began with language problems. She stated that she did not know the right part of her body and that she could not do mathematical calculations, which is medically known as Gerstmann’s syndrome. For this reason she was evaluated in neurosurgery.
“We performed a tomography and we observed a lesion inside the brain. In a magnetic resonance study we identified a nodular lesion with well-defined borders and a large cerebral edema”.
Subsequently, neurosurgery was scheduled, a highly specialized procedure in which medical technologies such as surgical microscope, neuronavigator and trans-surgical ultrasound are used. The purpose of making an access to the tumor located in the deep part of the brain.
After the intervention, the patient began a motor, language and calculation rehabilitation program that currently continues at home.