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The following is a transcript from the surgeons office. It covers the events up to the time of surgery.
NEUROSURGICAL ASSOCIATES, LTD.
Minneapolis, Minnesota
6/30/98: Michael and his parents returned to the office today for a followup discussion. We initially saw the child on 6/20/98 when he was presented to Minneapolis Children's because of the identification of a cystic lesion. This child was born 11/8/96. He was presented at 20 months because the father and mother noted a history of falling the prior day. When it continued to happen on the 20th and dad noticed some ataxia to his gait and leaning toward his left side, he was concerned. Then the child told him that things were not right and so he insisted on being seen at his local clinic where an evaluation was undertaken. At that time a CT scan showed a cystic lesion in the posterior fossa. He was admitted and started on Decadron, and underwent further evaluation. An MRI study was completed, which shows a cystic lesion that appears to arise from the lateral wall of the fourth ventricle at the CP angle on the right side. The child was then stabilized with Decadron and discharged home with the plan to readmit him on July 1 for surgery.
The patient and family have come to the office now and again for some additional discussion regarding the surgical intervention. We have undertaken these discussions at the hospital, but obviously this is a very serious undertaking and we wanted the opportunity to use models and drawings to help with the understanding of the surgical intervention, as well as to outline the risks and benefits of the procedure. They are pleased to report that the child, himself, has been making steady progress since being on the Decadron. They realize now that he has become really quite nonverbal over the past few months and now that he is feeling better he is very talkative, is speaking out words and even sentences. They think his balance and gait have improved. He still has a torticollis or head tilt which is probably compensatory to a sense of diplopia. He has, however, in the past week been learning to play basketball with his dad and is actually doing quite well.
In light of all this, we discussed again the surgical incision, the postoperative concerns for his cranial nerve dysfunction, for airway and swallowing safety, for physical therapy and occupational therapy for gait disturbance, extremity weakness and possibly paralysis. The duration of all these symptoms are difficult to predict at this time, as is the length of the hospital stay. The parents asked very appropriate questions. They seem to have a comprehension of the seriousness of the situation and surgical intervention, but feel comfortable in going forward with the planned procedure. They certainly are encouraged to give us a call if they have any questions preoperatively.
Therese O'Fallon, CNRN, CANP
for Muhmoud G Nagib MD
cc: John Hollerud MD
Lisa and Tony (parents)
William B Wheeler MD
Anne E Bendel MD
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The Beginning