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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

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paediatric brain tumour challenges
Paediatric Brain Tumour Challenges

Owen Sparrow

Patient & Carer Information Day: Brainstrust (Meg Jones) & Samantha Dickson Trust Nov 2010

patient spectrum
Patient spectrum
  • Age range < 16/19/25?
  • Varying patient engagement
  • Varying parental involvement
  • Expectations
  • Desperate measures
  • Patient best interest
where do they occur
Where do they occur?
  • Anywhere in the head…
  • In the eye socket
  • Skull base
  • Throughout the spinal cord (canal?)
how common are they
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
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
What are the symptoms?
  • Determined by the site:
  • Visual
  • Motor
    • Gait
    • Co-ordination
    • Posture
  • Sensory
    • Numbness
    • Tingling or similar
what are the symptoms1
What are the symptoms?
  • Unrelated to the site:
  • Pressure
    • Due to mass
    • Due to hydrocephalus
  • Epilepsy
  • Haemorrhage
what are the treatment options
What are the treatment options?
  • Diagnosis
  • Surgery
  • Chemotherapy
  • Radiation
  • Surveillance
what to choose
What to choose?
  • Observation/symptomatic
  • Curative
    • Surgical excision
    • Radiotherapy
    • Chemotherapy
  • Palliative
    • Life-enhancing
    • Life-prolonging
tumour examples
Tumour examples

Initially unsuspected…

antenatal hydrocephalus
Antenatal Hydrocephalus
  • Routine USS
  • Worsening hydrocephalus
  • Options
    • Await delivery
    • Induce labour to treat
    • Treat in utero?
tumour examples1
Tumour examples

Benign tumour

Difficult site…

lateral ventricular lesion 1
Lateral ventricular lesion 1
  • 15 Year old boy
  • 3 weeks of headache
  • Vomited twice
  • Visual obscurations
  • Papilloedema
  • Minimal gait ataxia
lateral ventricular lesion 2
Lateral ventricular lesion 2
  • 12 Year old girl
  • 2 days diplopia
  • Papilloedema