Coming Back to Life – an extraordinary case at Fortis

Life came crashing on the 30 year old IT professional from Bengaluru, Tuhin Bose on 15th of October when he was rushed to Fortis, Anandapur, early morning with dropping heart rate and drowsiness. An MRI detected a tumor in the fourth ventricle compressing the brainstem and cerebrospinal fluid pathway. What he initially thought to be a simple headache, turned out to be a tumor.

Tuhin was planning to get married in November but this incident made everything go haywire. The deterioration in his condition was quite rapid and he was rushed to the hospital. The tumor was obstructing the pathway of Cerebrospinal Fluid (CSF). This fluid circulates in and around the brain and if its pathway is obstructed, it can cause increase of pressure in the brain and eventually cause death. In Tuhin’s case, the tumor was compressing the brainstem, which is also responsible for heartbeat, breathing, consciousness, eye movements, balance, control of limb movements, facial movements, etc.

Without wasting time, he was quickly wheeled into the operating room. The tumor was in the fourth ventricle, which is a cavity through which CSF flows. This cavity is right behind the brainstem and in front of the cerebellum, a part of the brain responsible for maintaining our body balance. With extreme caution, the tumor was dissected from these vital structures completely and the pressure on the brainstem was released with the normal CSF flow established. The operation was a grand success.

In medical terms this was a classic case of “Hemangioblastoma”. Hemangioblastomas are rare tumors that occur in blood vessels of the brain and spinal cord. They may appear anywhere in the brain but are most often found in the cerebellum and the brainstem in the lower back section of the skull called the posterior cranial fossa. It is estimated that hemangioblastomas make up only 1 percent to 2.5 percent of all brain tumors.

 Although hemangioblastomas are benign (noncancerous) tumors, if they are located adjacent to a vital structure they can pose a serious threat and are difficult to treat. They attach to the pia mater, the innermost layer of the membranes surrounding the brain and spinal cord (the meninges), deriving their blood supply from this source.

While there is no known cause for most hemangioblastomas, about 25 percent of the tumors are linked to a genetic syndrome called von Hippel-Lindau (VHL) disease, a condition that also includes vascular abnormalities in the retinas and an increased risk of developing cancers in various organs, such as the kidneys, adrenal glands and pancreas.Hemangioblastomas associated with von Hippel-Lindau disease often recur after surgical removal.

To rule out VHL an abdominal ultrasound was conducted and it was clean.

Seeing that the patient survived the operation well, the family’s next question was whether he will be able to lead a normal life and whether the family should postpone the marriage. However, Dr. Amitabha Chanda was confident that Tuhin should do well and should be able to get married.

Tuhin finally made it to his wedding day without any hitch.

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