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The Therapeutic Challenge Essay

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DISSEMINATED GERMINOMAS The Therapeutic Challenge INTRODUCTION The prospect of tumours in the paediatric population is heart wrenching for parents and caregivers alike. The instinctive need for humans to care and protect their offspring leads to emotions of despair, anguish and hopelessness. Neurosurgeons are familiar with these emotions, as brain tumours represent the second most common paediatric tumour(1). Germinomas, even though rare, are unique to the paediatric population and adequate treatment of these tumors tend to have a good prognosis. In a few patients, there can be spread of the tumour, usually along the cerebrospinal fluid pathways with distant metastases being rare(2). Patients with this disseminated disease tend to present a unique challenge in managing the disease process. CASE A 16 year girl presented to the Accident and Emergency department of the University Hospital of the West Indies with a history of worsening headaches, vomiting and drowsiness. She had a history of having a suprasellar lesion resected one year previously that was diagnosed histologically to be a germinoma. A ventriculoperitoneal shunt had been placed to treat her postoperative hydrocephalus and she received conformational radiotherapy post operatively and was during well until the time of presentation. On presentation she was completely blind, and had no history of fever, seizures or weakness. On examination she had a Glasgow Coma score of 15 with no motor
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