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Low grade astrocytomas in the West of Scotland 1987-96: treatment, outcome, and cognitive functioning
S M Yule1, T A Hide, M Cranney
1Department of Haematology, Royal Hospital for Sick Children, Yorkhill NHS Trust, Yorkhill, Glasgow G3 8SJ, UK.
Insights
Early diagnosis of pediatric low-grade astrocytomas is crucial. While survival rates are high, prolonged symptoms of increased intracranial pressure significantly predict long-term intellectual disability in children.
Area of Science:
- Pediatric neuro-oncology
- Central nervous system tumors
Background:
- Low-grade astrocytomas are common pediatric central nervous system tumors.
- These tumors present significant challenges in terms of long-term neurodevelopmental outcomes.
Purpose of the Study:
- To identify risk factors associated with persistent intellectual handicap in children with low-grade astrocytoma.
- To investigate the impact of preoperative symptoms on cognitive function post-treatment.
Main Methods:
- Retrospective review of 30 pediatric low-grade astrocytoma cases (1987-1996).
- Cognitive assessment of 13 patients one year post-treatment for intracranial tumors diagnosed between 1992-1996.
- Analysis of tumor location, treatment modalities, and correlation with intellectual outcomes.
Main Results:
- Tumor locations: cerebellum (59%), thalamus (17%), cerebral hemispheres (10%), cervical spinal cord (9%).
- High survival rate (97%) at median 75-month follow-up.
- Persistent cognitive impairment was common one year post-treatment; duration of increased intracranial pressure symptoms preoperatively was the strongest predictor of IQ scores.
Conclusions:
- Pediatric low-grade astrocytoma offers an excellent survival rate.
- Significant long-term disability, particularly cognitive impairment, is a concern.
- Early diagnosis and management are essential to mitigate postoperative cognitive morbidity.
Background:
Low grade astrocytomas are among the most common central nervous system tumours in children.
Aims:
To identify risk factors for the development of persistent intellectual handicap.
Methods:
The notes of 30 children with histologically proven low grade astrocytoma who presented during the period 1987-96 were reviewed. Thirteen of these children who were diagnosed with intracranial tumours between 1992 and 1996 underwent cognitive assessment one year after the completion of treatment.
Results:
Low grade astrocytomas were found in the cerebellum (59%), thalamus (17%), cerebral hemispheres (10%), and the cervical spinal cord (9%). Where possible all patients were treated with gross total resection of the tumour. Symptomatic children with tumours judged to be inoperable underwent biopsy followed by radiotherapy (13%). Three patients developed progressive disease following surgery and underwent repeat surgery and radiotherapy. Survival at a median follow up of 75 months (range 30-131) is 97%. At one year after the completion of treatment persisting cognitive impairment was common. The strongest predictor of IQ scores was the duration of symptoms of increased intracranial pressure preoperatively.
Conclusions:
Although the overall survival rate of children with low grade astrocytoma is excellent, significant long term disability occurs. Early diagnosis is essential to reduce postoperative cognitive morbidity.