Thus, it appears, although not directly stated, that the arachnoid cyst is larger or is compressing the visual apparatus, while the rest of the findings on the scan may be about the same. In the light of the above, the patient's father asked the neurosurgeon a number of questions. I will provide a few comments, and then answer those same questions.
If the arachoiud cyst has enlarged and is truly exerting compression toward the visual apparatus, then yes, surgery to decompress or remove the cyst is reasonable and medically indicated. Indeed, then, yes, I agree with all the answers from the neurosurgeon below.
A) Is the operation essential? YES
B) Are there any similar cases for objective parallels? NO
C) Could Alessandro lose his sight completely if he doesn’t undergo surgery? YES
D) Risks of surgery? VERY HIGH I might temper this response. All neurosurgery has high risk, but this is not an unusual brain operation but one that is relatively straightforward.
E) Advantages of surgery? THE PATIENT WON’T LOSE HIS SOUND EYE SIGHT
F) Can chemotherapy replace the operation? NO. I strongly agree. Chemotherapy will not shrink a fluid-filled cyst.
G) After chemotherapy will surgery be necessary in any case? YES
Is chemotherapy necessary now? No, following surgery first, the child’s vision should be reassessed by the ophthalmologist. We would maintain our previous recommendation about whether to start or not start chemotherapy. If the patient has clear significant and notable decline of visual function by fields (i.e., loss of fields) or acuity (i.e., acuity less than the United States measurement of 20/40-20/50 OU), then we would commence chemotherapy. Moreover, if the solid (not cystic) portion of the tumor on MRI is much greater than previous, say 25-33% bigger, then yes, we would start chemotherapy. But, if the visual status has not changed by the criteria I mention or the tumor not 25-33% bigger, then we would observe and not give chemotherapy. We would not be scared into starting chemotherapy just because the child has tortuous optic nerves or a mass at the chiasm, both frequent findings in many children with neurofibromatosis.