Two and a half year old boy had increasing headache, unsteadiness of gait. He had features of raised ICP and truncal ataxia. Ciss-3D images [my favourite MR sequence -shows such exquisite details of cisternal anatomy!] clearly show the extension of tumor into the right foramen of Lushka. Tumor showed patchy enhancement.
Midline suboccipital craniotomy and complete excision was possible since tumor attachment to the floor of the fourth ventricle was small and well circumscribed.
Surgeons:I and VS Hari
Intraop problems: Difficulty visualising and excising the extension of the tumor into the right foramen of lushka [since our microscope does not have turnable eyepiece]. The lower cranial nerves were preserved intact and were visualised after excision of tumor from the foramen of Lushka. Lack of self retaining Leyla retractors was not much of a problem.
Post op complication - developed CSF leak, and high cell counts in ventric CSF, following superficial surgical site infection. Organism was sensitive to vancomycin and patient quickly responded and recovered completely from this potentially life threatening complication.
A VP shunt, although not desirable, was inserted since an early operation theatre slot was not available.
Close follow up is planned. No adjuvant treatment as of now.
