condition after craniotomy/spastic

[irremax]

Hi, I'm looking for some answers. I am 29 years old, female and live in Germany. I had two craniotomies in the space of 14 months to remove an epidermoid from my brainstem (4-12th nerves involved).After 1st surgery I suffered some nasty complications (infection, brainbleed, epileptic fits). 3 months after the last surgery my daughter was born, 6 months post-op everything was OK,  then increasing headaches, rightsided spastic, (hand now totally lame), vision problems, trigeminal neuralgia, focal fits, muscle cramps, shortterm memory problems, nausea.Recent MRI showed moderately enlarged ventricle (liquorräume) on the right side. EEG not pathological. Is it usual for such symptoms to appear a whole 6 months after surgery? Last surgery was 2 years ago and no sign of improvement. I like running and would like to run 2 marathons this year (already ran last year and year before-10 months post-op) but symptoms and pressure feeling in head have increased and stop me from training and are affecting my work.
Could this little surplus fluid be the cause? are symptoms reversible or (conservatively or operatively)even treatable? Psychsomatic causes were excluded by my neurologist(who also works as a psychiatrist). Is this type of situation common after this type of operation?
Thankful for any help,
irremax.

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.      
  Brainstem epidermoid cysts are very rare, but the case you describe is very typical.  Epidermoid cysts are benign tumors, but when they are located in tight spaces (like the brainstem) they push on vital structures and cause symptoms.  These tumors grow slowly (have bee present since birth) and generally result in clinical symptoms between the ages of 20-40.  The most common symtom is hemiparesis (weakness on one side) along with headaches, double vision, facial weakness and swallowing problems.  During surgery the epidermoid capsule and cyst fluid are removed.  It is often the case that the epidermoid capsule it tightly wrapped around the nerves and blood vessels in the area.  This causes bleeding and nerve damage in some cases and in many cases a small amount of the epidermoid capsule is left behind (which can lead to a recurrance).  The symptoms that you have developed 6 months after surgery are related to 2 possibilities.  Number one is hydrocephalus (fluid on the brain).  This is caused by blocking of the spinal fluid flow pathway (called the cerbral aqueduct->fourth ventricle). This fluid block causes pressure and fluid to buildup and can result in the symptoms that you describe of headaches, visual problems, memory problems and make old problems worse such as the right sided weakness. The reason for the fluid block is scar tissue from the surgery that develops adhesions and blocks flow or tumor recurrance.  Number two would be the possibility of tumor recurrance, that is pressing on structures in the brainstem again causing symptoms (right sided weakness) and causing hydrocephalus.  The treatment is to relieve the pressure that is either done by more surgery (to debulk recurrant tumor) or to place a shunt to re-route the spinal fluid flow.  I would recommend an MRI of the brain with CINE flow study to evaluate the flow of your CSF.  I would also recommend an ophthalmolgist evaluation for any signs of increased intracranial pressure.
I hope this has been helpful.

[irremax]

Sorry, that should be muscle spasms not cramps. I think I also forgot to write that all symptoms affect the right side of my body only. The enlarged ventricle is the fourth. Cerebellum also shows scarring. Thanks for your time, Irremax

[squeemy]

A related discussion, 12 years after brainstem epidermoid cyst removed was started.