How to Conduct Rehabilitation After Brain Tumor Surgery?

How to Conduct Rehabilitation After Brain Tumor Surgery?

Disclaimer:  

The online Q&A is not a treatment recommendation. Due to the inability to understand the patient's detailed condition and provide face-to-face diagnosis, the expert opinions are for reference only. For specific treatment plans, please visit a reputable hospital.

This edition of the "Expert Q&A" features Dr. Liang Ping, a neurosurgeon at Chongqing Medical University Affiliated Children's Hospital.

Dr. Liang Ping is a nationally recognized advanced worker in the health and family planning system. He serves as the deputy leader of the Pediatric Neurosurgery Group in the Chinese Medical Association's Neurosurgery Branch, a committee member of the Pediatric Malignant Solid Tumors Surgery Committee of the National Health Commission, a committee member of the Pediatric Neurosurgery Committee of the Chinese Medical Doctor Association, the vice president of the Neurosurgery Committee of the Chongqing Medical Association, an advisor for the Pediatric Neurosurgery Group of the Chongqing Medical Association's Neurosurgery Branch, and the deputy chairman of the Neurosurgery Committee of the Chongqing Association of Traditional Chinese and Western Medicine.

01  

Q: A 10-year-old boy was diagnosed with a brain tumor at age 8 and has completed treatment. He underwent craniotomy on September 9, 2021, with a pathology report indicating glioblastoma (grade 4). Later reports from Beijing's Xuanwu Hospital, 301 Hospital, Fudan University in Shanghai, and Johns Hopkins identified it as sarcoma! After finishing radiotherapy and chemotherapy, there was no follow-up treatment. He is currently normal with no apparent sequelae. An MRI shows results similar to before. I want to know if this can metastasize throughout the body or if it will recur at the original location in the left temporal lobe?  

A: I am not sure if the sarcoma you mentioned refers to gliosarcoma. Gliosarcoma is a subtype of glioblastoma, and it is currently established that there are two subtypes of gliosarcoma:  

1. Gliosarcoma primarily composed of sarcomatous components;  

2. Gliosarcoma primarily composed of gliomatous components.  

Gliosarcomas rarely metastasize outside the cranium or diffuse into cerebrospinal fluid, with most recurrences occurring at the original site; however, sarcomatous gliosarcomas show a higher probability of extraneural metastasis.

02  

Q: An 8-year-old boy was diagnosed with a brain tumor at age 7 and is currently undergoing treatment. An MRI on October 2, 2022, showed a mass in the right frontal parietal lobe. He underwent a total resection on October 11 in a Shanghai hospital, with a rapid frozen section indicating a low-grade spindle cell tumor, but the final pathology reported a high-grade embryonal tumor. Concerned about the differing results, we sought a consultation at Huashan Hospital, which concluded it was a pediatric glioma. Subsequently, he was evaluated at Xinhua Hospital and the Ackerman Institute in Shanghai, where they diagnosed it as a high-grade neuroepithelial tumor with EWSR1 rearrangement. He later received 12 sessions of local radiotherapy and 16 sessions of whole-brain and whole-spinal irradiation (2.0 Gy each). He is currently on the sixth round of chemotherapy.  

Should we conduct further pathology tests? Is it necessary to change the treatment for the embryonal tumor? What is the cure rate, and what is the recurrence rate?  

A: If gene testing indicates a high-grade neuroepithelial tumor with EWSR1 rearrangement, the results should be relatively clear. This tumor is quite rare, and current research is limited. If chemotherapy for the embryonal tumor has already been initiated, you can continue the treatment while regularly following up with MRI scans. Although the histopathological results indicate a neuroepithelial tumor classified as low-grade, the genetic testing suggests EWSR1 rearrangement, which, when combined with the genetic results, still classifies it as a high-grade neuroepithelial tumor. Since this tumor was only defined in recent years and follow-up time is relatively short, the cure rate may not be very reliable. In limited case reports, the probability of recurrence is over 90%.

03  

Q: An 11-year-old boy was diagnosed with a brain tumor at age 9 and has completed treatment. He underwent surgery in Beijing, but suffered a stroke during the operation and was in a coma for six months. He has received seven rounds of chemotherapy and 30 sessions of radiotherapy. After the fourth chemotherapy, he regained consciousness but has been bedridden since, with motor disabilities, swallowing difficulties, a nasogastric tube, tracheostomy, and is unable to speak. He experiences tremors in his head and upper limbs. How can we approach rehabilitation treatment?  

A: Currently, rehabilitation treatment plans in the country are becoming increasingly sophisticated. You can visit a large tertiary hospital's rehabilitation department to develop a suitable rehabilitation treatment plan and provide comprehensive rehabilitation intervention. During different stages of treatment, it is crucial to analyze the main issues and address them accordingly. Regular rehabilitation assessments should be conducted during treatment to adjust the treatment plan and optimize therapeutic effects.

Chief Editor: Chen Xiaoping  

Formatting: Xia Yu  

Proofreading: He Fei