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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(02): e48-e52
DOI: 10.1055/a-2297-4265
Case Report

Nuanced Management of a Skull Base Tumor in the Setting of Relapsed Acute Lymphoblastic Leukemia

Geena Jung
1   Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
,
Emery Buckner-Wolfson
1   Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
,
Adit Tal
2   Department of Pediatrics, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
,
Ryan Fatemi
1   Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
,
Timothy Kim
1   Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
,
Genesis Liriano
1   Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
,
Andrew Kobets
1   Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States
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Abstract

Introduction Relapsed acute lymphoblastic leukemia (ALL) involving the central nervous system (CNS) is a significant issue that contributes to both morbidity and mortality. Given the poor outcomes in patients with CNS relapse, understanding how ALL involving intracranial relapse presents and is treated is critical. Here, we present a complex case of relapsed recurrent ALL in a pediatric patient.

Case Report An 11-year-old patient presented with double relapse of ALL in the form of an extensive skull base lesion and again with leptomeningeal disease. For the skull base lesion, she was treated nonsurgically with chemotherapy and radiation, which led to a remarkable reduction in the size of the lesion. However, she was found to have early recurrence with leptomeningeal enhancement resulting in hydrocephalus 5 months after completing therapy. A shunt was placed successfully. Currently, she is being managed with monthly intrathecal chemotherapy with cerebrospinal fluid sampling and bone marrow biopsies every 2 months.

Discussion We report the significant effect of chemotherapy and radiotherapy in reducing the size of the extensive skull base lesion, saving the patient from the risks associated with surgery. This patient's initial relapse, with a large skull base lesion that had intracranial involvement, is an unusual presentation of relapsed ALL. The additional early recurrence of leptomeningeal disease further makes this case unique and the management even more nuanced. Here, we demonstrate a multidisciplinary approach for the successful treatment of our patient, which can help guide the management of similar patients in the future.

Keywords

skull base tumor - acute lymphocytic leukemia

Ethical Approval and Consent to Participate

Approval for the publication of this work was granted by the Albert Einstein IRB and consent to publish this report was obtained from the patient's family.


Consent for Publication

Consent for publication was obtained from the patient's family.


Authors' Contributions

G.J., E.B.W., R.F., and T.K. were involved in the composition of this manuscript and A.T., G.L., M.B., A.K. were involved in revision and review of this manuscript. G.J. and A.K. developed the concept for this report.




Publication History

Received: 14 December 2023

Accepted: 17 January 2024

Accepted Manuscript online:
01 April 2024

Article published online:
30 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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