A recent MRI revealed a 1.3cm mass in the pons area of my son's brain stem. He underwent MRI with and without flare, CAT scan, angiogram, spinal tap, and many blood test in 4 days. The doctors do not know what it is; they say it could be MS, tumor, or angiographically occult vascular malformation.(most likely the AVOM) Due to the location we have not had much hope in treating the mass. My son is suffering with headaches, ear ache, hearing loss, night sweats and some past numbness in the leg. My question is: What can be done for a mass in the pons. Is there a blood test that will rule out cancer? Is the gamma knife used in the pons? We were told that biopsy would only give a 50-50 chance of walking out of the hospital. He is only 26, Is nothing that can be done?
Dear A. Wynne,
The pons is located in a region that connects the brain to the rest of the
body, the brainstem, and has traditionally been difficult to access surgically.
Motor and sensory function to the extremities as well as most of the cranial
nerves are some of the functions subserved or affected by the pons. As such,
this is neurologically 'expensive' territory.
It is difficult to assess what may be going on in your son's brainstem. Much
of the assessment depends on what is seen on the MRI and other studies that
have been done, as different lesions have different characteristic appearances
on these studies. As you noted, your son may have a brainstem glioma, AOVM,
or MS, though MS is less likely. It is difficult to say without seeing the
films and examining your son. It doesn't sound like your son is terribly
symptomatic from this lesion as one would expect weakness or numbness of the
arms or legs coupled with various cranial nerve deficits. Whether or not
a biopsy is warranted is unclear as well. Often treatment for a tumor can
be initiated without tissue diagnosis in this location.
Much of what should be done for your son both diagnostically and therapeutically
will be driven by the appearance on the studies that have been done. If the
physicians are unclear as to what this is, you may choose a second opinion
to a neurologist or neurosurgeon of your choosing. An appointment can be made
at the Cleveland Clinic with a Neurosurgeon by calling 216-444-5672.
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