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Brain Tumors in Pediatrics PowerPoint Presentation

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Description : Check out this medical presentation on astrocytoma in childhood, which is titled "Brain Tumors in Pediatrics", to know about brain tumors in children, its treatment, and chance of recovery.

Tags : astrocytoma, childhood, Pediatric, Brain Tumors, treatment, recovery, Hydrocephalus, Astrocytoma, Juvenile Pilocytic astrocytoma, Glioblastoma Multiforme, Medulloblastoma, Brainstem Glioma, Signs, Symptoms

Published on : May 06, 2021 | Views : 2686 | Downloads : 2

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Slide 1-

Brain Tumors in Pediatrics Resident Education Lecture Series
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Brain Tumors - Background 20-30% of cancers in children 2500-3000 new diagnoses/year 2nd most common neoplasm Most occur before age 10 years Male/Female = 1.3/1.0 60-70% 5 year survival
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Relative Incidence of Brain Tumors in Children Table 25-1. Approximate incidence of common CNS tumors in children. Pizzo & Poplack
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Location – Supra vs. Infra Supratentorial 25-40% Astrocytoma, low grade 8-20% Astrocytoma, high grade 6-12% Ependymoma 2-5% Mixed glioma 1-5% Ganglioglioma 1-5% Oligodendroglioma 1-2% PNET 1-2% Choroid plexus tumor 1-2% Meningioma 1-2% Germ Cell Tumors 1-2% Other 1-3%
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Location – Supra vs. Infra Infratentorial 45-60% Medulloblastoma (PNET) 20-25% Astrocytoma, low grade 12-18% Ependymoma 4-8% Brain stem glioma, high grade 3-9% Brain stem glioma, low grade 3-6% Other 2-5%
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Brain Tumors - Signs/Symptoms Increased intracranial pressure - symptoms Headache (am) Nausea/vomiting (am) Double vision Head tilt Decreased alertness Lethargy/irritability Poor feeding, FTT Endocrine dysfunction Unexplained behavior changes - affect, motivation, energy level
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Brain Tumors – Signs/Symptoms Increased ICP – Signs Papilledema, optic atrophy Loss of vision OFC (head circumference) increased Bulging fontanelles, spreading sutures “Setting sun” sign (Parinaud syndrome) Increased blood pressure, low pulse  herniation?
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Posterior Fossa & Brainstem Tumors - Clinical Features Posterior Fossa primary Ataxia Tremors Dysarthria Stiff neck Papilledema Brainstem primary Extremity weakness Cranial nerve signs double vision facial weakness swallowing dysfunction
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Hemispheric Tumors – Clinical Features Hemiparesis Hemianopsia Aphasia Seizures
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Treatment Tumor Type Surgery XRT Chemo Medulloblastoma +++ CrSp +++ Low grade astro +++ focal ---- cerebellar +++ ???? ---- optic glioma NO ???? ???? High grade astro/GBM +++ +++ ? Brain stem glioma (exophytic) focal ? Ependymoma +++ focal ---- Germ cell tumor ? bx +++ +++
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Treatment - Surgery In general, needed for diagnosis - exceptions: GCT, BSG Ideal is gross total resection Balance prognosis vs. morbidity Debulking, shunts, reservoirs - for symptom/ICP reduction, therapy
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Treatment – Radiation Therapy Potential for use in all brain tumors exceptions: choroid plexus tumors Neuro-axis prophylaxis (cranio-spinal rx) if tumor disseminates via CSF Concerns for long term effects neuro-cognitive hearing secondary cancers endocrine skeletal growth
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Therapy - Chemotherapy Adjunct therapy in most cases particularly in GCT, medulloblastoma Of interest in young children (avoid or prolong XRT) Blood brain barrier may be limiting Newer studies suggest this may not be so Local delivery via pumps/reservoir/IT
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Medulloblastoma/PNET Similar histology, different tumor names based on location. Therapies vary Medulloblastoma - posterior fossa PNET - supratentorial Pineoblastoma - pineal region median age 5 years M:F = 2:1 propensity to disseminate 1/3 with metastatic disease at diagnosis
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Medulloblastoma Prognostic Factors Age - Younger tend to do worse Extent of resection Non-posterior fossa tumors Non-localized disease Standard risk 70-80% 5 yr survival High risk 50% what are risk groups?
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Medulloblastoma CSF dissemination check for leptomeningeal spread brain/spine MRI, LP Can spread to lung, liver, BM, bone, LN’s – rare Difference between supratentorial PNET (sPNET), medulloblastoma, and pineoblostoma?
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Ependymoma 10% of childhood brain tumors Median age = 3-4 yrs 2/3 of primary in posterior fossa May have leptomeningeal spread - MRI of brain/spine, CSF Prognostic factors: Extent of resection!!! Age: some reports of better survival if > 5-7 years at diagnosis Histology
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Ependymoma - continued Extent of resection most important Near to gross total resection 50-75% Less than NTR 0-30% Radiation therapy helps survival Reduces local recurrence Chemotherapy has not shown efficacy Recurrence is rarely fixable
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Brain Stem Gliomas Diffuse intrinsic pontine gliomas median survival = 6-9 months death within 2 years > 90% Radiation - transient clinical improvement Low grade gliomas tectal, exophytic, extra-medullary highly enhancing on MRI more indolent
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Low Grade Astrocytoma/Glioma 30-35% of CNS tumors 40-50% supratentorial, virtually anywhere M:F = 2:1 Association with NF-1 more indolent course GTR  >90% 5 year survival RX Radiation Chemo if symptomatic, progressive, or recurrent
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Brain Tumors in < 3 year olds 60-70% supratentorial XRT has significant neuro-cognitive effects Goal of therapies: Delay XRT to at least 3 yrs old with chemotherapy  most relapse prior to XRT Current study Short course (16 wks) chemo 2nd look surgery Focal (conformal) XRT Maintenance chemotherapy
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Complications From Tumor/Therapy Neurological deficits limb paresis Rehab/PT/OT, support swallowing/speech dysfunction ENT, Speech therapy Nutrition issues neuro-cognitive deficits School/education issues Social interaction issues endocrine dysfunction end-organ damage kidney, liver, hearing, neuropathy
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Pediatric Brain Tumors Leading cause of morbidity/mortality in pediatric cancers Need for aggressive supportive care Need for palliation
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From ABP Certifying Exam Content Outline Recognize the signs and symptoms of craniopharyngioma Recognize the clinical manifestations of brain tumor Recognize the physical characteristics of a headache due to increased intracranial pressure Differentiate the clinical manifestations of spinal cord compression (eg, from a tumor) from those of other myelopathies, and evaluate appropriately
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Credits Sachin Jogal MD