Expert: Claes-Gustaf Nordquist, M.D. - 7/3/2008

Question
My wife was diagnosed in '91 with a 3 cm astrocytoma grade III on the optic chiasm. She had a debulking procedure and did well. She lost vision in her left eye, no other deficits. In December '07 she experienced dramatic loss of short-term memory, confusion and sleep 12-16 hours/day. MRI revealed growth of the tumer to 9 cm extending to the right frontal lobe, midbrain, and posteriorly to the cerebral peduncles. It was resected from the frontal lobe by approximately 2.5 cm. Symptoms: increased loss of short-term memory, difficulty initiating movement, incontinence, confabulation of thoughts, poor oreintation to date/day/time, increased loss of vision (20/200) with recent loss of sight in the center of her medial visual field. She has right temporal hemianopsia. The neurosurgeon said he encountered a significant amount of scar tissue from the previous surgery.
What is the prognosis? What treatment do you recommend? We f/u with the neurosurgeon in two weeks. I greatly appreciate your opinion.

Answer
This was a hard question! Based on her very long medical history (17 years) I wonder if the grade of her tumor was correctly evaluated back in 1991. The grade was probably lower (a 2 or a 1). Due to the recent behaviour of her tumor I wonder if there has been a change of the grade of the tumor (to a higher number). Has any pathology studies been done on her tumor after her recent surgery? In order to answer your question I would need to know what that pathology report showed. If you can provide that I'll be better able to answer.