Makindo Medical Notes

🧠 Brain tumours are the most common solid tumours in children, making up ~20% of childhood cancers. They can occur in the cerebrum, cerebellum, brainstem, or spinal cord, producing diverse symptoms depending on location and size. ✨ Advances in imaging, neurosurgery, radiotherapy, and chemotherapy have significantly improved survival and quality of life in many children.

📊 Common Types of Paediatric Brain Tumours

• Medulloblastoma: Fast-growing tumour in the cerebellum, causing gait imbalance and raised ICP. Most common malignant brain tumour in children.
• Pilocytic Astrocytoma (low-grade astrocytoma): Usually benign, slow-growing, and often curable with surgery. Often arises in the cerebellum or optic pathway.
• Ependymoma: Originates from ependymal cells lining the ventricles; can obstruct CSF flow → hydrocephalus.
• Brainstem Glioma: Includes DIPG, aggressive and inoperable, affecting cranial nerves, swallowing, and breathing.
• Craniopharyngioma: Benign but locally invasive tumour near the pituitary gland, leading to endocrine dysfunction and visual loss.

⚠️ Symptoms (depend on location & size)

• 🌅 Morning headaches (↑ intracranial pressure)
• 🤢 Nausea & vomiting
• 👀 Vision or hearing changes
• 🤸 Problems with balance or coordination
• ⚡ Seizures
• 🧩 Behavioural or cognitive decline (school performance issues)
• 👶 In infants: bulging fontanelle, increasing head circumference

🔍 Diagnosis

• Neuroimaging: MRI (preferred) ± CT for acute hydrocephalus.
• Neurological exam: Cranial nerves, motor, gait, fundoscopy (papilloedema).
• Biopsy: Histology & molecular profiling guide treatment.
• Multidisciplinary team: Paediatric oncologists, neurosurgeons, radiologists, endocrinologists, neurologists.

💊 Treatment Options

• 🛠️ Surgery: Aim for maximal safe resection to relieve mass effect and obtain histology.
• ☢️ Radiotherapy: Effective but long-term effects (endocrine, neurocognitive) limit use in <12 years. Proton therapy is emerging to reduce toxicity.
• 💉 Chemotherapy: Used in medulloblastoma, high-grade gliomas, or to delay radiotherapy in young children.
• 🎯 Targeted Therapy: E.g., BRAF inhibitors for BRAF-mutant gliomas; immune checkpoint inhibitors under study.
• 🤝 Supportive Care: Dexamethasone for raised ICP, ventriculoperitoneal (VP) shunt for hydrocephalus, physiotherapy, occupational/speech therapy, school reintegration support.

📈 Prognosis

• Pilocytic astrocytoma: Excellent survival with complete excision (>90%).
• Medulloblastoma: ~70% 5-year survival with surgery + craniospinal irradiation + chemo.
• DIPG: Poor prognosis; median survival ~9–12 months despite therapy.
• Ependymoma: Variable; outcome depends on resectability and molecular subtype.
• Craniopharyngioma: Benign but recurrent; long-term endocrine & visual morbidity common.

⚠️ Complications

• Hydrocephalus → may require VP shunt/ETV.
• Neurocognitive impairment from tumour or therapy.
• Endocrine dysfunction (growth hormone, thyroid, adrenal, puberty issues).
• Secondary malignancy post-radiotherapy.

🔬 Outlook & Research

• Genomic profiling → more precise therapy.
• Trials on immunotherapy & tumour vaccines.
• Focus on reducing long-term neurocognitive & endocrine sequelae.

📚 References

• American Cancer Society – Childhood Brain Tumours
• NHS – Brain Tumours in Children
• UpToDate – Paediatric Brain Tumours