Management of pediatric brain tumors, strategies and long term outcome

Transcription

1 Management of pediatric brain tumors, strategies and long term outcome SAN The Sudanese association of neurosurgeons By Dr. Abubakr Darrag Salim Ahmed Dr. Mohammed Awad Elzain Khartoum Sudan

2 Pediatric brain tumors are a well Known major condition of morbidly and mortality. In the literature it considered as the main cause of mortality but in some sources it is only preceded by hemopiotic malignancies.

3 Both prospective and Retrospective, observational study for all Sudanese children with brain tumors operated the author in the period between September 2000 to March 2015.

4 Age in groups Frequency Percent 20 Age in groups year % 6-10 years % years % 10 8 More than 15 years 5 9.3% Total % year 6-10 years years More than 15 years 5

5 Sex Distribution : Gender Frequency Percent Sex male 34 63% 37% female 20 37% 63% male female Total %

6 Clinical Features Mental changes Diplopia Sphincteric Disturbance Insomnia Speech disturbance Dizziness Limb Spasticity Uncontrolled movements Dysmetria Unsteady gate Neck pain Convulsions Vomiting Blurring of vision Headache Loss of conciousness 7,40% 11,10% 13% 11,10% 13% 16,70% 22,20% 20,40% 26% 27,80% 33,30% 42,60% 42,60% 48,10% 59,80% 90,70% 0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00% 80,00% 90,00% 100,00%

7 Neurological Deficit 38,90% present absent 61,10%

8 Duration of symptoms in months

9 Co-existing hydrocephalus Frequency Percent present 34 63% absent 20 37% Total %

10 Operative procedure Frequency Percent Parietal craniotomy % Parietal craniotomy and Marsupialization 1 1.9% Reservoir insertion 1 1.9% Frontal craniotomy + reservoir insertion 2 3.7% Frontal craniotomy 3 5.6% Pterional craniotomy % Lt eye evisceration + Lt pterional craniotomy 1 1.9% Fronto-parietal Craniotomy 2 3.7% Bifrontal craniotomy 1 1.9% Temporal Craniotomy 1 1.9% Posterior fossa craniectomy % Total %

11 Degree of tumor resection: Management of pediatric brain tumors, Degree of Surgical Resection Frequency Percent Total % Subtotal 20 37% Debulking % Total %

12 Histopathology Frequency Percent Meduloblastoma Astrocytoma Haemangioma Haemangioblastoma Pilocytic astrocytoma Not clear Oligodendroglioma Haemangiopricytoma Retinoblastoma Hydatid cyst Vascular malformation Glioma Ependymoma Anaplastic astrocytoma Diffuse astrocytoma Craniopharyngioma Total

13 No complications % Infection 1 1.9% Respiratory failure 5 9.3% CSF leak 1 1.9% Sever hemorrhage 1 1.9% Diabetes insipidus 1 1.9% Intracranial bleeding 1 1.9% Convulsions 1 1.9% Bulbar palsy 1 1.9% Blindness and difficult walking 1 1.9% Overshunting 1 1.9% Obesity 1 1.9% Total %

14 Outcome Frequency Percent Cured % Improved % Static 1 1.9% Deteriorated 1 1.9% Died % Total %

15 Causes of Deaths Causes of Deaths Frequency Percent Respiratory failure % Sever Hemorrhage % Infection % Brain Herniation % Increased ICP % Unknown % Total 9 100%

16 Age Distribution: The youngest was 1 year old and the oldest was 18 years old (mean 9.4 +/- 4.8) Management of pediatric brain tumors, 6 years lady Headache, Vomiting,Blurring vision, disturbed gait. For few months. CT MRI VP Shunt First Tumor resection Histo : Medulloblastoms

17 Age Distribution: The youngest was 1 year old and the oldest was 18 years old (mean 9.4 +/- 4.8) Management of pediatric brain tumors, 7 Years Lady Presented with headache, blurring vision and unsteady gait Operated by shunt and then tumor resection on 16/8/2006 She finished radiotherapy sessions The only abnormality seen on her is some transverse nystigmus.

18 Age Distribution: The youngest was 1 year old and the oldest was 18 years old (mean 9.4 +/- 4.8) Management of pediatric brain tumors, 8 years Boy presented with headache vomiting, blurring vision, neck pain and unsteady gait operated on 14\1\2007 Histo ( Pilocytic astrocytoma ) completed radiotherapy sessions, presented in 30\5\2010, normal vision, no fits Presented in 2013 with shunt exposure and calcification shun revision done.

19 ) Management of pediatric brain tumors, 11Years boy presented with headache blurring vision and vomiting Shunt done first Then Total craniecotmy tumor resection No radiotherapy Cured

20 Age Distribution: The youngest was 1 year old and the oldest was 18 years old (mean 9.4 +/- 4.8) Management of pediatric brain tumors, 6 years young lady presented with headache,blurring vision, neck pain, vomiting, unsteady gait for 2 months Shunt and tumor resection done in the same session

21 Management Strategies adopted by us Early Diagnosis as much as possible Early intervention Family support and help to take right decision Hydrocephalus has priority Maximal surgical resection with great care to preserve normal brain Aid of microscope, Neuronavigation, CUSA, Microsurgical sets Expertise anesthesia and ICU team with adequate blood and fluid replacement

22 Management Strategies adopted by us Early physiotherapy, mobilization Multidisciplinary Team approach with help of Pediatric neurologist, Neuroradiologst Neuro-Oncologist, and pediatric psychiatrist Adequate long term follow up for any Physical, mental, cognitive, Educational and social disabilities.

23 CSF diversion CSF diversion is a priority in case of presence of clinical or radiological hydrocephalus To relieve symptoms To operate on a relaxed brain To guard against future hydrocephalus due to recurrence, infection, adhesions We prefer to do VP high pressure shunt either separated or in the same session as tumor resection Some times we do ETV or EVD in the same session but we found it associated with some problems such as tense brain, recurrence of hydrocephalus or??? infection We do not remove shunt unless it causes problems.

24 Conclusions Pediatric brain tumors are among the most challenging neurosurgical problems The management needs stepwise multidisciplinary team. The lesions tend to be Mostly infratentorial with obstructive hydrocephalus. In our center it is found that 2 steps surgery first with VP shunt followed by second stage tumor resection after few weeks is both effective and safe way with apparently good outcome.

25 Thank You for your attention

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28 4 th Middle East Spine Society Congress Rabat, Morocco May 10-13, 2017

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