Paediatric Brain Tumors.pdf - Pediatric Brain Tumors Dr...

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Pediatric Brain Tumors Dr Jeremy Omondi Department of Paediatrics Uzima University, Kisumu
Introduction Brain tumors are the commonest solid tumors in children <15 years The second commonest pediatric cancer Approximately 20% of all malignant neoplasms Incidence 3.3/100000/year
Incidence of common Brain tumors in children
Etiology Cause unknown in most cases Risk factors - Ionizing radiation - Specific genetic syndromes - Neurofibromatosis 1 associated with optic gliomas; - Tuberous sclerosis associated with subependymal giant cell astrocytomas .
Classification of Brain tumors 1. Histological classification 2. Anatomic site
Histological classification Tumors of neuroepithelial tissue - Astrocytic tumors - Oligodendroglial tumors - Ependymal tumors - Mixed gliomas - Neuronal and mixed neuronal-glial tumors - Choroid plexus tumors - Pineal parenchymal tumors - Embryonal tumors(PNET,MB,ATRT)
Histologic classification cont’d Tumors of non neuroepithelial tissues - Meningeal tumors - Germ cell tumors - Tumors of the sellar region Metastatic tumors
Anatomic classification Supratentorial (30-50%) Midline (10 -15%) Infratentorial(posterior cranial fossa tumors, 50 -60%)
Tumor distribution and age Age Location Tumor types Under 1 year supratentorial Gliomas Teratomas PNET Choroid plexus 1 to 11 years Infratentorial >supratentorial Medulloblastoma Ependymoma Brainstem Over 11 years Infratentorial = supratentorial Gliomas PNET/Medulloblastoma Germ cell tumors
Symptoms and Signs Commonest manifestation is due to increased intracranial pressure Increased ICP caused by tumor mass obstructing CSF flow, Tumor associated edema or mass effect of the tumor Headache Nausea and vomiting Irritability Lethargy Changes in behavior Gait and balance disorders
Clinical presentation Presenting features vary and may delay diagnosis Depend on age of child, tumor location and size May mimic common childhood illnesses Infants- lethargy, irritability, increased head circumference, bulging fontanelle, vomiting Older children: as for infants plus - Seizures, headaches, early morning vomiting - Changes in vision - Focal neurological signs
Presentation according to anatomic site Supratentorial(40 - 50%) - Raised ICP, seizures - hemiparesis/Focal neurology - Hypothalamic/pituitary dysfunction - visual field defects Infratentorial(50 - 60%). - Raised ICP, headaches and vomiting - Truncal unsteadiness, cerebellar ataxia - cranial nerve palsies - CN VI- Double vision, unable to move eyes laterally - CN VII- facial droop, unequal smile
Presentation cont’d Primary spinal tumors - These are rare - Ddx ependymomas, astrocytomas - May present with cord compression CNS metastases of extracranial tumors, rare

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