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Paediatric Brain Tumour Challenges. Owen Sparrow. Patient & Carer Information Day: Brainstrust (Meg Jones) & Samantha Dickson Trust Nov 2010. Patient spectrum. Age range < 16/19/25? Varying patient engagement Varying parental involvement Expectations Desperate measures - PowerPoint PPT Presentation
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Paediatric Brain Tumour Challenges
Owen Sparrow
Patient & Carer Information Day: Brainstrust (Meg Jones) & Samantha Dickson Trust Nov 2010
Patient spectrum
• Age range < 16/19/25?• Varying patient engagement• Varying parental involvement• Expectations• Desperate measures• Patient best interest
Where do they occur?
• Anywhere in the head…• In the eye socket• Skull base• Throughout the spinal cord (canal?)
How common are they?
• 400 per annum in UK (nearly 60 m)• 20 per annum in Southampton• Catchment population 3 m
How do they behave?• Completely indolent to aggressive cancers• Range– Confined, benign & surgically curable– Infiltrative, but indolent– Malignant, but local disease, so curable– Malignant, spreading in CSF (round brain & spinal cord)– Malignant, spreading outside of nervous system– Bleeding– Deformity
What are the symptoms?
1 Determined by the site:
• Visual• Motor
– Gait– Co-ordination– Posture
• Sensory– Numbness– Tingling or similar
What are the symptoms?
2 Unrelated to the site:
• Pressure– Due to mass– Due to hydrocephalus
• Epilepsy• Haemorrhage
What are the treatment options?
• Diagnosis• Surgery• Chemotherapy• Radiation• Surveillance
What to choose?
• Observation/symptomatic• Curative– Surgical excision– Radiotherapy– Chemotherapy
• Palliative– Life-enhancing– Life-prolonging
Tumour examples
Initially unsuspected…
Antenatal Hydrocephalus
• Routine USS• Worsening hydrocephalus• Options– Await delivery– Induce labour to treat– Treat in utero?
Antenatal MR
Post-natal Ultrasound
6 Weeks Later
Tumour examples
Benign tumourDifficult site…
Lateral ventricular lesion 1
• 15 Year old boy• 3 weeks of headache• Vomited twice• Visual obscurations• Papilloedema• Minimal gait ataxia
Lateral ventricular lesion 1
Lateral ventricular lesion – post-op
Lateral ventricular lesion – post-op
Lateral ventricular lesion 2
• 12 Year old girl• 2 days diplopia• Papilloedema
Lateral ventricular lesion 2
Lateral ventricular lesion 2
Lateral ventricular lesion – post-op
Lateral ventricular lesion – post-op
Lateral ventricular lesion – post-op
It’s not always so simple…