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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. Age range < 16/19/25? Varying patient engagement Varying parental involvement Expectations Desperate measures

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Paediatric Brain Tumour Challenges

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  1. Paediatric Brain Tumour Challenges Owen Sparrow Patient & Carer Information Day: Brainstrust (Meg Jones) & Samantha Dickson Trust Nov 2010

  2. Patient spectrum • Age range < 16/19/25? • Varying patient engagement • Varying parental involvement • Expectations • Desperate measures • Patient best interest

  3. Where do they occur? • Anywhere in the head… • In the eye socket • Skull base • Throughout the spinal cord (canal?)

  4. How common are they? • 400 per annum in UK (nearly 60 m) • 20 per annum in Southampton • Catchment population 3 m

  5. 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

  6. What are the symptoms? • Determined by the site: • Visual • Motor • Gait • Co-ordination • Posture • Sensory • Numbness • Tingling or similar

  7. What are the symptoms? • Unrelated to the site: • Pressure • Due to mass • Due to hydrocephalus • Epilepsy • Haemorrhage

  8. What are the treatment options? • Diagnosis • Surgery • Chemotherapy • Radiation • Surveillance

  9. What to choose? • Observation/symptomatic • Curative • Surgical excision • Radiotherapy • Chemotherapy • Palliative • Life-enhancing • Life-prolonging

  10. Tumour examples Initially unsuspected…

  11. Antenatal Hydrocephalus • Routine USS • Worsening hydrocephalus • Options • Await delivery • Induce labour to treat • Treat in utero?

  12. Antenatal MR

  13. Post-natal Ultrasound

  14. 6 Weeks Later

  15. Tumour examples Benign tumour Difficult site…

  16. Lateral ventricular lesion 1 • 15 Year old boy • 3 weeks of headache • Vomited twice • Visual obscurations • Papilloedema • Minimal gait ataxia

  17. Lateral ventricular lesion 1

  18. Lateral ventricular lesion – post-op

  19. Lateral ventricular lesion – post-op

  20. Lateral ventricular lesion 2 • 12 Year old girl • 2 days diplopia • Papilloedema

  21. Lateral ventricular lesion 2

  22. Lateral ventricular lesion 2

  23. Lateral ventricular lesion – post-op

  24. Lateral ventricular lesion – post-op

  25. Lateral ventricular lesion – post-op

  26. It’s not always so simple…

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