Three months ago, a case was discussed in the multidisciplinary tumor board. A 17-month-old child was admitted through the ER with a posterior fossa tumor (brain tumor) and multi-level spinal cord compression due to tumor deposits. The tumor was so extensive that only a biopsy could be performed rather than maximum safe resection. The biopsy report was discussed in the MDT (it was medulloblastoma), and after considering the neurological deficits and age of the child, it was decided to provide the best supportive care; in other words, not to do anything.
However, the parents were very keen for treatment. When we saw the child, he was cute, very chubby, and had nystagmus in both eyes. Bilateral lower limb powers were zero, upper limb powers were 3/5, and GCS was 9-10/15. The parents were so adamant that they wanted some treatment and didn’t want a death sentence.
Children younger than three years are usually not given radiation because of possible long-term side effects with brain development. Instead, they are treated mainly with surgery and chemotherapy. However, in this case, after obtaining informed high-risk consent, we started the craniospinal irradiation of the patient, and the child started developing sepsis. The craniospinal irradiation was stopped, and sepsis treatment began. Craniospinal irradiation was stopped and resumed multiple times due to altered periods of sepsis.
Over the course of two months, all the departments became so emotionally attached to the child that he even started responding to most of us. The only good part is that the child started improving neurologically. Today was the last day after months of his CSI, and he is moving his lower limbs, talking, can take food by mouth, and his nystagmus is gone. Although we don’t know about the future, we did our best, and days like these make me believe in the power of prayer, in the power of hard work, and the emotion that we put in for our patients. Sometimes, magic happens.
