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…