"Today is my 4th birthday!" Renji Neurosurgery team extended two life images for patients with intracranial glioblastoma | Lao Ye | Mother cells

"Next year, we will celebrate our 5th birthday together!" In the 10th floor ward of the Neurosurgery Department of Renji Hospital affiliated with Shanghai Jiao Tong University School of Medicine, 54 year old Ye and the medical staff who came to inspect the ward celebrated a special "4th birthday" and made new wishes.

Four years ago, Lao Ye suddenly became paralyzed on the left side and was diagnosed with the most malignant and worst prognosis glioblastoma, with an average survival time of only 14.6 months. Try to remove the tumor as much as possible to ensure survival, while striving to preserve the functional area of the brain. Zhang Xiaohua, the director of neurosurgery, is giving it a try, allowing Lao Ye to create miracles every day after his rebirth. A year ago, the tumor recurred again, which was very similar to three years ago, but everything was different. Zhang Xiaohua changed her second surgery strategy to focus on maximizing the survival time of the elderly. Compared to the confusion and despair of the first time, Old Ye and his wife showed extra optimism and strength this time. "We have been four years and have the confidence to keep going like this."

The first operation, precise tumor resection to preserve function

First surgery, precise tumor resection to preserve function

Old Ye, who has just turned 50, has always been in good health. Four years ago in early June, he ran 8 kilometers the day before, but the next morning without warning, he experienced left limb weakness and couldn't hold his chopsticks. The illness came so fiercely that the next afternoon, Lao Ye's left limb was paralyzed and he could only walk slowly with his left leg dragging.

At this moment, the Lao Ye family realized that at that stage, Lao Ye suddenly experienced significant memory decline. The examination result was like a bolt from the blue: there was a tumor in his brain with a diameter of nearly 4 centimeters. The tumor is large in volume, highly malignant, and invades brain functional areas closely related to limb movement. After going through multiple hospitals, Old Ye's family was on the brink of collapse. Old Ye's wife admitted, "He had already wanted to give up. If he couldn't move in bed after surgery, he might not have the courage to live."

After finding Zhang Xiaohua, the director of the neurosurgery department at Renji Hospital, the family saw hope.

"Old Ye is only 50 years old and still very young. If he wants to completely remove the tumor but the patient becomes paralyzed from then on, this is definitely not an ideal result. In the surgery, we will balance these two." After carefully examining the body and reviewing the images, Zhang Xiaohua provided the surgical plan to Old Ye's family: the tumor is highly malignant and should be removed as much as possible to ensure survival; On the other hand, from the perspective of quality of life, efforts will also be made to preserve brain functional areas.

Zhang Xiaohua arranged the bed as quickly as possible. On June 5, 2019, after completing preoperative examinations and precise evaluations, Zhang Xiaohua led the surgery and Jia Feng and Jin Yichao acted as assistants to perform craniotomy on Lao Ye. Under the guidance of neuronavigation and electrophysiological monitoring, Zhang Xiaohua accurately avoided the functional areas and important blood vessels at the edge of the tumor, and after 5 hours, successfully removed the huge tumor in the right frontal lobe.

After the surgery, Lao Ye experienced multiple levels such as high fever and epilepsy. The postoperative pathological report gave the worst result - glioblastoma, the most malignant type of glioma with the worst prognosis, with an average survival time of 14.6 months. With the cooperation of the neurosurgery medical and nursing team, Lao Ye overcame difficulties and was discharged more than 10 days later. Fortunately for the old Ye family, his physical activity was not affected. With the help of his family, Lao Ye miraculously walked out of the hospital.

In the following year, Lao Ye received postoperative synchronous radiotherapy and chemotherapy, as well as intensified treatment with temozolomide, developed by the brain tumor MDT team of Renji Hospital. The tumor progression was effectively controlled. The haze that enveloped the family gradually dissipated, returning to their usual life and work, taking walks and traveling, and experiencing the beauty of "rebirth" to the fullest.

But glioblastoma is still difficult to escape the fate of recurrence. In July 2022, an imaging follow-up showed that the tumor in the brain of the old lobe, which had been "silent" for more than 3 years, had recurred, accompanied by weakness of the left limb, which was very similar to that of 3 years ago! However, compared to the confusion and despair of 3 years ago, Lao Ye and his wife are particularly optimistic and strong.

Second surgery after tumor recurrence to maximize survival time

However, glioblastoma ultimately cannot escape the fate of recurrence. In July 2022, an imaging follow-up revealed a recurrence of a tumor in the brain that had been dormant for more than three years, accompanied by weakness in the left limb, which was very similar to three years ago! However, compared to the confusion and despair three years ago, Old Ye and his wife appeared particularly optimistic and strong.

In the following six months, Zhang Xiaohua's brain tumor MDT team conducted temozolomide chemotherapy for Lao Ye, while also implementing targeted and gamma knife therapy with enrotinib. Magnetic resonance imaging reexamination suggests that the tumor is constantly progressing. At the end of February 2023, Zhang Xiaohua decided to perform a second surgery on Lao Ye after a comprehensive evaluation of the condition and analysis of the entire diagnosis and treatment process. Due to the larger scope of tumor recurrence, the main goal of the second surgery was to preserve function. Therefore, the second surgery should consider a larger range of tumor resection, with a focus on maximizing the patient's survival time.