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Speech slur, difficulty walking, shaking hands. Is MRI needed?

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Hi, This is regards to my mother who has been experiencing some speech slur, hand shaking, and difficulty walking reasonable distances. She is 65, 5'5", 72 kgs and resides in India. They ran through several tests and were finally suggested a brain MRI.

The diagnosis by a neurologist in consultancy with a neurosurgeon was the following:
1.Tectal plate Cavernoma causing obstruction of aqueduct.

2. Dilated 3rd and lateral ventricles.

A shunt procedure to drain the CSF was suggested.

Upon consulting a second neurosurgeon, a shunt procedure followed by a surgical correction of the source of the problem was suggested. It was not clarified by me whether this surgeon diagnosed it as a Cavernoma or another issue.

With the original MRI in hand, we consulted a neurosurgeon and neuro-radiologist here in the US, with the help of a mutual contact, and their reading of it was it was not a cavernoma, but a Ependymoma, in the wall of the ventricle, located near the Pons in the brain and Cereballa aqueduct, thus causing the blockage in CSF draining. It was suggested that along with a shunt procedure, a followup surgery to remove the tumor should be done. They also suggested MRI of the spine to rule out tumors there.

My questions are the following:

- Are the diagnosis received cause for immediate concern, i.e., does the shunt procedure have to be done immediately? (I can upload MRI scans as needed)
- Considering the difference in opinion is it better to have procedure done here in the US? Is the particular expertise and operating facilities required in this case highly advanced and available more pervasively here in the US? (Any ballpark cost estimate would be fantastic)
- What are the recovery timelines and complications (if any) for a surgical remove of the tumor?

Please guide in any possible way. Thanks so much in advance!

Category: Neurosurgeon

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Dr. Goutham Cugati
Category: Spine Surgeon
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 24 Doctors Online

Expert:  Dr. Goutham Cugati
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Hello,
Thank you for your query at DoctorSpring.com
Surgery for CSF diversion is mandatory. Standard procedure is inserting a shunt. The better and less invasive alternative is Endoscopic Third Ventriculostomy. Surgery needs to be done at the earliest. Many centres of excellence are available in India who do it. Cost may vary from 60k to 4 lakhs depending on the centre.
Regarding the excision of the tumour I would like to comment after seeing the scans.
Feel free to discuss further,
Regards.


Patient replied :

Hi Dr. Goutham, thanks a lot for your response!
You can access the DICOM files here (under folder 'DICOM'): https://drive.google.com/folderview?id=0BxF2cBg2og_Samxld1ZQRDhUOUE&usp=sharing
It can also be viewed by downloading the entire folder onto a WIndows machine and using the included Syngo viewer.
Q1. Reading about the ETV, the effectiveness seems better suited for certain cases than other. Could you comment further by looking at the MRI?
Q2. About the cost estimate, could you clarify if this is for the shunt placement or for the ETV?
Q3. Also looking forward to hear your thoughts on the root problem (cavernoma/tumor) and next steps for that. How long normally would the recovery time be for such a procedure, and are there any common complications or possible relapses?
Thanks in advance!
Regards


Expert:  Dr. Goutham Cugati
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Hello,
I am sorry there are more than 1000 images and each had to be downloaded individually. Please send the dicom images in a zip file. Or if possible send the jpg images.

Tectal region tumours with dilated lateral and third ventricle patients are the ideal fit, hence I would recommend ETV. The cost which I mentioned holds good either for Shunt or ETV.
You can mail the images to [email protected]


Regards

Dr Goutham Cugati

Consultant Neurosurgeon


Patient replied :

Thanks for your reply. I have created a zip of the DICOM files and sent a link to the mentioned email.
The zip file can also be accessed using this link: https://drive.google.com/file/d/0BxF2cBg2og_ST1d5SzZGbzlwQTQ/view?usp=sharing
It could not be forwarded as attachment to email or uploaded on your site, as it is about 200MB.
Please let me know if you have any diffculties with the download.
Thanks,
- Kiran


Expert:  Dr. Goutham Cugati
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Dear Sir,

I have gone through the scans. The best option is to plan for a ETV. During the same time the surgeon can have a view of the tumour. If he is having best of the skills, then he can plan to remove part or whole of the tumour through endoscope itself.

The prognosis and outcome depends on the type of the tumour, which can be ascertained after the biopsy report.


Dr Goutham Cugati

Consultant Neurosurgeon


Patient replied :

Thank you doctor! Could you please make a suggestion on 1-2 better equipped facilities in Bangalore that have the personnel to perform ETV and tumor removal?
Thanks!


Expert:  Dr. Goutham Cugati
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Hello
At Bangalore.... To my knowledge, the best place is Narayana Hrudyalaya.

Best neurosurgeon for endoscopic surgery in India would be Dr Yadav, Jabalpur.
Regards

Dr. Goutham Cugati
Category: Spine Surgeon
Experience: 
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
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