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CT Scan Showed Posterior Fosse/3rd Ventricular Colloid Cyst With Hydrophane. Any Treatment?

Posted on Tue, 4 Dec 2012

Question: Case summery of the patient

patient was in her normal state of health back, when she reported to department of accident and emergency with severe headache and vomiting following which patient last her consciousness. CT scan brain was done which showed posterior fosse / 3rd ventricular colloid cyst with hydrophane, following which patient was shifted to emergency OT and drainage procedure was done, mean while patient developed aspiration and letter ARDS/ Aspiration pneumonia. Patient was shifted to surgical intensive care unit for ventilatory support, meanwhile patient was again shifted to emergency operation theatre and B/L VPMP shunt was done, patient was again shifted to surgical intensive care unit for ventilator support and check CT were performed which revealed proper functioning of the shunts with 3rd ventricular tumor. Patient was on ventilator support for one week. then patient got shifted to the neurosurgery ward( tracheotomies in SICCU) put on oxygen via tracheotomy, regular tracheotomy suctioning done, tracheotomy tube size reduced from cuffed 8 to cuffed 6 and then to un-cuffed 5 size. Patient come with GCS 15 then immediately dropped to 4/5 and score of patient is E/4 V/T M/2(Glasgow score). Secretions via tracheotomy have thirmed out at and decreased in quantity. Regular physiotherapy, suctioning, change of postures gain in, patient febrile and in view of that Antibiotics stopped.
After checking CT again showing B/L hydrocephalus in view of that revision of B/L VPMP Shunts done and patient again put on Antibiotics.

Answered by Dr. Vineet Saggar (6 hours later)

Dear Friend,

Thanks for providing a detailed account of this patient. It is not very clear though what you wish to know from me.

Though most of the brain tumours generally cause symptoms to be detected before causing these kinds of catastrophe; however due to nature of its location, collide cyst can cause sudden deterioration of patients which is sometimes beyond even what we can anticipate or help. Your patient has received best and correct treatment.
It was unfortunate that the shunt got blocked resulting in hydrocephalus. Such stunt blockage is a known complication occurring in 2-3 % of patients.

Since your patient is young and if present GCS is E4Vt M2. It is matter of time before she recovers.

I would like you to get an MRI repeated if feasible to see status of brain stem and its status in view of two episodes of brain herniation.

Have patience.

Hope I have provided some useful information. Let me know if you have any other specific queries.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Vineet Saggar (37 hours later)

i want to know is any other treatment for her.
and usually how much time it takes to recover.

Answered by Dr. Vineet Saggar (2 hours later)

Dear,

Thanks for writing back.

According to me, treatment received by this patient is adequate. If there are no other complications, we can expect recovery in a few weeks to months. However you should get MRI scan of the brain done to evaluate extent of damage to brain. The results of the MRI scan can give us clues about the next options of management.

Hope this answers your query. Let me know if there are other enquiries.

Regards
Dr.Vineet

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Above answer was peer-reviewed by : Dr. Prasad