The Case History of Robert
Robert is a 38 year-old right-handed man, born with congenital blindness of the left eye, who first presented with flashes of kaleidoscope-type color changes in his right eye around May 2004. His description of these symptoms were consistent with visual seizures, which are the abnormal, disorganized firing of neurons within the visual centers of the brain that may create the experience of flashes of light and/or color. Although he had had seizures in the past, these symptoms were new, so he underwent an MRI scan of his brain. MRI at the time revealed a mass in the occipital lobe, the main vision center of the brain, on the right side. After a trial of medical management with anti-seizure medications and serial MRI scans to see if the mass was actively growing, radiologic evidence of disease progression in September 2005 brought him to Ronald Reagan UCLA Medical Center in search of surgical treatment.
Dr. Linda Liau met Robert and decided that surgical resection of the mass would be the most appropriate treatment choice given his symptoms and increasing size of the lesion. As the mass was located in an area that would result in obvious neurologic deficits if disrupted (visual cortex), preoperative functional MRI (fMRI) and diffusion tensor imaging (DTI) data was obtained in order to help map out the relation of the mass to critical visual fibers for navigation in the OR. This helps the surgeon intraoperatively by guiding resection and avoiding areas critical for neurologic function. [Purple = visual fibers; yellow = tumor].
During the operation the mass was biopsied and found to be an oligodendroglioma, a low grade - less invasive - brain tumor. He tolerated the procedure well and no complications were experienced.
Robert remained in good health with no progression of disease until an MRI in November 2007 showed evidence of recurrent tumor. By this time, he had progressive loss of his left visual field, with only sparing of the central visual field on the left side. He was placed on Temodar chemotherapy, which he received 4 times over the course of 4 months, after which he underwent another craniotomy for further tumor resection in May 2008. Preoperative fMRI data was again integrated with anatomic images to help guide resection. The intraoperative biopsy of his tumor revealed that it had transformed into a more malignant variant called anaplastic oligodendroglioma. He had a gross total resection of his tumor. Postoperatively, Robert experienced difficulty with visual processing and a mild decrease in his visual fields. Since then he has enrolled in a Phase I dendritic cell vaccine trial at UCLA, a novel experimental therapy that utilizes the patient's own immune system to help fight off cancer. He has received his first two vaccinations and is doing well to date.
Preoperative Functional MRI
T2 Axial view: |
Diffusion Tensor Imaging
3D view: |
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