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Първи отговор на Doz. Dr. med. Hans Clusmann

Dear Mrs. Zaharieva,

thank you for sending the letters and scans of the 7 year old male patient. The MRI scans dated 15th October 2007 show a recurent cystic formation in the posterior fossa. The tumor is diffuse in the brain stem predominantly on the left, however there seem to be several parts of exophytic tumor, which may be presponsible for the cys formation. Of course we will not be able to cure the patient, however, we think it is justified to reoperate on the child in order to remove significantly greater parts of the tumor. If histology will still be a pilocytic astrocytoma, postoperative radiation and perhaps also adjuvant chemotherapy should be evaluated.

Given the fact, that the clinical situation of the child is overall still ok, another surgical intervention may contribute to a stabilization of the situation for a considerable time period, however, as mentioned above, the tumor grow is diffuse, so that the surgical options are limited, but we think that more extensive surgery can be done without too much risk for the patient..

If you plan to have treatment here, please contact us again by email.

Sincerely, on behalf of Professor Schramm,

Priv.-Doz. Dr. med. Hans Clusmann
Oberarzt
Neurochirurgische Klinik
Universitätsklinikum Bonn
Sigmund-Freud-Str. 25
53105 Bonn

Tel: 49-228-287 16502/ 11350 / 16521
Fax: 49-228-287 16772
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Martin Emilov Zahariev, 7 years old, born 3200 gr. and 50 cm of first normal pregnancy and normal birth. Congenital syndactyly (webbed fingers) of the hands – 3 and 4 fingers, feet – 2 and 3 fingers. At the age of 1.5 and 2 he underwent two surgeries for splitting the fingers of his hands. Martin began to speak difficultly. When he was 2 years old, the following diagnosis was established: hyperkineticity, retarded speech development, dyspraxia, dysphasia. Reflectory paresis on the right and general muscular hypotonia. The child was not given the diagnosis infantile cerebral palsy because he is able to move.

Until March 2007 the child developed very well; he used to go to school. In March problems with his eyesight occurred – paralytic strabismus of the left eye. The paresis of the right side became stronger, the child started to stagger. We made computer tomography – the results were negative. A month later we made magnetic resonance tomography and then the tumor was discovered. So far, two surgeries were made with two different histological results. During the surgeries there were only removed the cysts and tissues was taken for histology. The problem is that cysts are formed all the time and they worsen the child’s condition. We are encl osing medical reports. Can you help us?

Ivelina Zaharieva Varna, Bulgaria

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