Wednesday, February 22, 2017

Brain tumors in Children

Though rare, brain tumors are the most common form of solid tumors among children under the age of 15 and represent about 20% of all childhood cancers.  Brain tumors in children are often located in different locations and behave differently than brain tumors in adults.  Consequently, management of tumors in children varies from that in adults.  Children with tumors may also have a much better prognosis than adults with a similar condition.

Understanding Tumors
There are different brain tumor types and classifications based upon a tumor’s cell of origin, cell type, composition, rate of growth and other characteristics. 

Most pediatric brain and spine tumors are primary tumors, meaning they originated in the brain or spine.  In contrast, the most common brain tumors in adults are metastases, meaning they represent spread of a tumor located elsewhere in the body, such as the liver, breast, lung and kidney. Primary tumors are classified as “benign” or “malignant.” Both can be life-threatening.

A child’s body makes cells when they are needed for development or repair.  A tumor develops when normal or abnormal cells multiply when they are not needed.  The words “benign” and “malignant” are generally used to describe how normal or abnormal the cells are when viewed under a microscope.  Tumors with cells that are similar in appearance to normal cells are called “benign.”  Tumors with cells that appear very different than normal cells are called “malignant.” A number of factors are taken into consideration while classifying the tumor as 'benign' or 'malignant'. 

Prognosis is a prediction about the future course of the disease and the likelihood of recovery.  Prognosis is based upon many factors including the type of tumor, its location and grade, the length of time your child has exhibited symptoms, the speed of growth, and treatment options.  The age of the child and the extent to which the tumor has affected the child’s ability to function are also important factors.

Brain Tumors in Children
The most common types of brain tumors in children are astrocytoma, medulloblastoma and ependymoma, however below is a full listing of pediatric tumor types.

Malignant - Medulloblastoma, PNET, ATRT, Ependymoma, Choroid plexus carcinoma, Anaplastic astrocytoma, Glioblastoma

Benign - Pilocytic astrocytoma, craniopharyngioma, choroid plexus papilloma, ganglioglioma, neurofibroma

Treatment Options 
Treatment of brain and spine tumors in children is different than treating adults. Children’s brains and bodies are still developing, so there are different considerations and standards of care. For most children, treatment starts with surgery. Histopathological examination following surgery will help to classify and grade the tumor. 

Following surgery, additional treatment may be required.  Possible therapies include:

  • Chemotherapy
  • Conventional radiation therapy
  • Stereotactic radiosurgery
  • Interventions to address side effects of the tumor or the treatment
  • Rehabilitation to regain lost strength and skills
  • Ongoing follow-up care to detect recurrence of the tumor and manage late effects of treatment

Complications following treatment

Treatment of brain tumors, benign or malignant, may involve morbidity leading to distress in the family. Some of the complications of treatment include
  • Physical disabilities such as weakness of muscles and diminished coordination 
  • Learning disabilities including problems with memory, attention, comprehension and information processing
  • Behavioral changes and emotional issues
  • Hearing and vision problems 
  • Seizures and other neurological issues  
  • Hormonal problems including slowed growth, hypo- or hyperthyroidism, diabetes, early or late puberty, and infertility
  • Damage to internal organs and/or other body systems 
  • The possibility of developing secondary cancers in other parts of the body or a recurrence of a tumor in the brain
Timely diagnosis and treatment by a multidisciplinary team helps achieve the best possible outcomes in children with brain tumors. 

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Thursday, February 9, 2017

'Stroke Facts' Questionnaire

Please fill out the following questionnaire to see if you know the basics of 'Stroke'

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Stroke Literacy Questionnaire

Wednesday, February 1, 2017

Preparing for Brain Tumor Surgery

Whenever someone in the family is diagnosed with a 'Brain Tumor', it causes a lot of apprehension in in the family. Surgery is usually the first step in treating most benign and many malignant tumors. It is often the preferred treatment when a tumor can be removed without unnecessary risk of neurological damage.

Surgery might be recommended to: 
• Remove as much tumor as possible
• Provide a tumor tissue sample for an accurate diagnosis and for genomic testing
• Remove at least part of the tumor to relieve pressure inside the skull (intracranial pressure), or to reduce the amount of tumor to be treated with radiation or chemotherapy
• Enable direct access for chemotherapy, radiation implants or genetic treatment of malignant tumors • Relieve seizures (due to a brain tumor) that are difficult to control with medications

“Radiosurgery” is a type of intense radiation delivered to a tumor. It may be used instead of, or in addition to, conventional surgery. Radiosurgery is not surgery in the conventional sense, as no opening is made in the skull. In certain cases, it may offer similar benefit and lower risk or discomfort than conventional surgery.

Before surgery your doctor will consider the following: 

• Location of the tumor. Where the tumor is located will determine whether it is operable or inoperable.

• Diagnosis and size of tumor. If a tumor is benign, does not cause intracranial pressure (due to its small size) or cause problems with sensitive areas, avoiding or postponing surgery might be considered.

• Number of tumors. The presence of multiple tumors creates additional challenges to safe removal.

• The borders, or edges, of the tumor. If the tumor is poorly defined around the edges, it may be mixed with normal brain tissue and more difficult to remove completely.

• Your general health. Are your heart, lungs, liver and overall general health strong enough to endure the strains of surgery? If this is a metastatic brain tumor (one which began as a cancer elsewhere in your body), is the primary cancer controlled?

• Your neurological status. Do you have symptoms of increased intracranial pressure? Are there signs of nerve damage possibly caused by the tumor? If so, further evaluation may be needed before surgery is attempted.

• Previous surgery. If you’ve had recent surgery, it is usually necessary to recover from the previous procedure before going through another one.

• Other options. Is it likely that another treatment would provide equal or better results at comparable or lower risk? Your doctor will take these points into consideration in forming your treatment plan.


An operable tumor is typically one that your doctor believes can be surgically removed with minimal risk of brain damage.


In some cases surgery may not be possible because the tumor is so deep within the brain that it is not accessible without excessive risk of brain damage. Tumors located in the brain stem and thalamus are two examples. Other tumors may present a problem if located near a sensitive area in the brain that controls language, movement, vision or other important functions. However, with advances in technology, the so called 'INOPERABLE TUMORS" can also not be safely resected with minimal damage to the surrounding brain.

Highly sensitive scans are used for this purpose and may include:
 • Computerized Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Magnetic Resonance Spectroscopy (MRS)
• Positron Emission Tomography (PET)

Diffusion Tensor Imaging MRI’s may be used to generate maps of the nerve pathways called “fiber tracking.” Use of fiber tracking may help the surgeon avoid disrupting important nerve connections within the brain itself. Vital areas can also be defined by a procedure called brain mapping. At the beginning of the surgery, tiny electrodes are placed on the outer layer of the brain. Stimulating these electrodes helps the neurosurgeon determine the functions of those sensitive parts of the brain so they can be avoided during surgery.


A craniotomy is the most common type of surgery to remove a brain tumor. “Crani” means skull and “otomy” means cutting into. The procedure typically involves shaving a portion of the head, making an incision in the scalp, then using specialized medical tools to remove a portion of the skull. This enables the neurosurgeon to find the tumor and remove as much as possible. After the tumor is removed, the portion of skull that was cut out is replaced, and the scalp is stitched closed. Remember, all of this is done with drugs that relax you or put you to sleep. They also numb the scalp and other tissues. The brain itself does Sample of a head frame used during stereotactic biopsy Electra, LSS frame not “feel” pain, so brain surgery can be done with you awake if the surgeon believes it is necessary to minimize the risk of the procedure.

A craniectomy is similar to a craniotomy in all ways except one. While “otomy” means cutting into, “ectomy” means removal. In a craniectomy the bone removed for access to the brain is not replaced before closing the incision. The neurosurgeon may perform a craniectomy if he or she expects swelling to occur following surgery, or if the skull bone is not reusable. When the bone is reusable it can be replaced at a later date when it will not cause additional pressure. The skull piece is stored by the medical facility until a time when it might be reused. If a craniectomy is done, you will receive instructions from your health care team for protecting the soft spot created by the missing bone.

A Stereotactic biopsy. The same procedure as a needle biopsy but performed with a computer-assisted guidance system that aids in the location and diagnosis of the tumor.

Transphenoidal surgery is an approach often used with pituitary adenomas and craniopharyngiomas. The term “trans” means through and “sphenoid” refers to the sphenoid bone located under the eyes and over the nose. The entry point for the neurosurgeon is through an incision made under the upper lip and over the teeth or directly through the nostril.

If a tumor has a large number of blood vessels, surgery can be difficult due to the bleeding that could result. Embolization is a technique neurosurgeons use to stop the blood flow to the tumor prior to removing it. A diagnostic test, called an angiogram, is performed to determine if a significant amount of blood is going to the tumor. If so, the neurosurgeon or neuroradiologist can insert a small “plug” made of wire or glue-like material into the vessel. This stops the blood flowing to the tumor, but not to normal parts of the brain. Tumor removal usually follows within a few days. This technique might also be used with tumors that contain a high number of blood vessels – referred to as “vascular” or “well-vascularized” tumors. Meningiomas, meningeal hemangiopericytomas and glomus jugulare tumors are typically well-vascularized tumors.

Brain tumor surgery poses both general and specific risks. The general risks apply to anyone going through surgery for any reason and are not limited to brain tumor surgery. These include:
• Infection
• Bleeding
• Blood clot formation (hematoma)
• Blood pressure instability
• Seizures
• Weakness
• Balance/coordination difficulties
• Memory or cognitive problems
• Spinal fluid leakage
• Meningitis (infection causing inflammation of membranes covering the brain and spinal cord)
• Brain swelling
• Stroke
• Hydrocephalus (excessive fluid in the brain)
• Coma
• Death

Risks specific to brain tumor surgery depend greatly on the particular location of the tumor. Particular areas of the brain control functions such as vision, hearing, smell, movement of the arms and legs, coordination, memory, language skills, and other vital functions. The process of operating on the brain always includes some risk that nerves or blood vessels serving these areas will be damaged. This could result in partial or complete loss of sensation, vision, movement, hearing or other functions. When a tumor is located deep within the brain it increases the risk and range of possible complications.

Any type of surgery is a trauma to your body. Some people will recover faster than others. While there is no “normal” recovery period that applies to all people, your recovery time will depend on:
• The procedure used to remove your brain tumor
• The part of your brain where the tumor was located
• The areas of your brain affected by the surgery
• Your age and overall general health

Ask your neurosurgeon what you can expect as a reasonable recovery time. This will help you set realistic goals for yourself in the weeks following surgery.

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