Mismanagement of Neuroblastoma Tumor in Young Child Leads to Untimely Death

This case involves a 4-year-old patient who was diagnosed with a neuroblastoma and was admitted for emergency surgery. The surgery was determined to be a success and a majority of the mass was resected. Over a several-week period following the surgery, the patient developed brain swelling which went undetected. The patient’s vital signs became unstable over a 3 day period at which point she was finally sent for a CT scan. The radiologist reported that there was swelling but no one elected to inform the neurosurgeon on call. After a few weeks passed (with no surgical intervention), the neurologist reviewed the patients brain imaging with the parents. He explained that the patient suffered catastrophic brain damage with the loss of over half her brain function. The patient became paralyzed and died several weeks later due to associated complications.

Question(s) For Expert Witness

1. Should these neurological complications have been noticed sooner?

Expert Witness Response E-001047

If the patient was unstable and worsening, then there should have been more urgent intervention, including consideration of neurosurgical issues. Brain swelling is non-specific and can often occur after surgery but can also suggest other etiologies such as hypoxic-ischemic brain injury, inflammation, etc. In any event, the decompensation of the patient should have been noticed sooner and actionable measures should have been taken much, much sooner. This is not only a sad case, but an unfortunate one.