Paediatric Brain Tumours

Question 1

What are the 3 main ways of classifying paediatric brain tumours?

Answer 1

Malignancy (how much of the tumour infiltrates the cells )
- Benign
- Semi-benign
- Semi-malignant
- Malignant

Histological Type (cell type)
- Neuroepithelial
- Mesodermal
- Ectodermal

Location
- Infratentorial
- Supratentorial

Question 2

What are the 3 main risk factors for poor neuropsychological outcomes in patients with paediatric brain tumours?

Answer 2

• Age at dx (younger = worse)
• Age at treatment (younger = worse)
• Type of treatment (radiotherapy = worse)

Question 3

What are 3 treatments for brain tumours in order of damage they can cause to the developing brain (from least to most severe damage)?

Answer 3

1) Surgery
2) Chemotherapy
3) Radiotherapy

Question 4

Describe the pathophysiology/pathological outcomes of radiotherapy treatment

Answer 4

• White matter changes
• Radiation induced dementia
• Focal cerebral necrosis
• Cerebrovascular disease
• Radiation induced hydrocephalus

Question 5

What are the general cognitive sequelae of radio therapy?

Answer 5

Effects are variable and tend to change over time (usually in a downwards direction)
- IQ
- Attention & Concentration
- Speed of processing
- Working memory
- Language
- New learning and memory
- Academic functioning
- Executive functioning

Question 6

List types of Posterior Fossa tumours

Answer 6

1. Cerebellar astrocytoma (relatively benign, good prognosis)
   2 . Medullablastoma (malignant and rapid growing, poorly demarcated)
2. Ependymoma (arises from 4th ventricle, poor prognosis)

Question 7

List types of midline tumours

Answer 7

1) Craniopharyngioma
2) Pineal tumours
3) Pituitary tumours

Question 8

What is cerebellar mutism?

Answer 8

A syndrome of mutism and subsequent dysarthria following removal of posterior fossa tumours. Often accompanied by personality changes, emotional lability and/or decreased initiation of voluntary movements. The spectrum of associated neurological and behavioural anomalies varies widely among patients. All cases regain language, but may be residual deficits in expression and reception

Question 9

What are two indirect ways tumours can impact cognitive/neuropsychological functioning?

Answer 9

• Impact of treatment
• Effect of fatigue
• Impact of missing school