Expert: Claes-Gustaf Nordquist, M.D. - 10/29/2009

Question
QUESTION: My dad this year was 74 years old. Around 3 years ago, my dad has headache and his leg is week cannot walk long distance. He only took a medicine to recover. However, my dad complained that his eye slowly get blur. Until this year, he wanted to seek for eye treatment. Since last month, my father started to have double vision, no appetite, his eye feel tired and always sleep. Until 2 weeks ago, we bough him to hospital and doctor diagnosed that his brain has 1.5cm tumor. Now the doctor still under investigating whether the tumor is dangerous / not. After went through MRI scan and his diabetic and high blood tention is under control, the doctor discharged him and make another appointment with Neurosurgeon for further treatment. But i was wondering why my dad has not undergo any surgery and others medical treatment, he still does not have much appetite where he just took x1- x2 spoons food, vomiting and always fall sleep but, he still can talk with us, walk to the toilet and recognize us, just sometime lost his memory. What will happen if my dad continue in this situations? According to the doctor, he is now under stable condition. But, I'm very worried about my dad as he totally cannot take much of food. Anyone can help me on this and what should i do for the next to safe my dad? PLEASE HELP !!!!. Thanks a lot.

ANSWER: Dear Crystal, all depends on what kind of tumour your father has. If it is a malignant brain tumour his prognosis is unfortunately bad in this situation. Brain surgery is rather complicated. Nothing can be done until his neurosurgeon has evaluated him. However from your description it seems likely that this indeed is a malignant tumour, so unfortunately it is probable that his treatment options and possible treatment results are limited. Please do keep me posted!


---------- FOLLOW-UP ----------

QUESTION: i got a report from MRI and the report stated as follow:-

Pituitary Protocol

Findings
1)The pituitary gland is enlarged with convexity of the superior aspects is seen. It measures 1.5x1.2x2.0cm (AP x WIDTH x CC)
2)High signal intensity of the posterior lobe on T1W is not seen
3)There is diffuse heteregenous enhancement noted post gado
4)The infundibulum is normal in signal intensity
5)The optic chiasma is being displaced superiorly by enlarged pituitary and there is extension of the mass into the right cavernous sinus
6)Left cavernous sinus is normal
7)No other abnormal signal return in the rest of the brain parenhyna
8)Ventricles and sulci are prominent due to age related cerebral atrophy

For your info, my dad told me yesterday that he don't have double vision anymore, no headache and no fever. Now only not much of appetite, sometime vomiting, eye always feel tired and wanted to lying on the bed.

If he is under bad condition, but why the neurosurgeon did not take immediate action for surgery/ taking any like chemo/ radio treatment?

Please advise on my father condition now.

Thanks a lot.


Answer
This is NOT an ordinary brain tumor, this is a pituitary tumor! Neurosurgery of this location is VERY tricky! It is probably easier for an ear-nose-and-throat surgeon to reach this location via sinus sphenoidale behind the nose! So his neurosurgeon should discuss this with an ear-nose-and-throat surgeon too. It is doubtful if chemotherapy or ordinary radiation therapy is of any use here. However stereotactic high dose radiation therapy (with the so called "GammaKnife") MAY be possible as an alternative to surgery. At least the size of the tumor would allow that. Even so I would probably prefer surgery so that we would know exactly what we are dealing with. Please do keep me posted!