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Long-term outcome in children with low grade tectal tumours and obstructive hydrocephalus
Femke K Aarsen1, Willem F M Arts1, Marie L C Van Veelen-Vincent2
1Department of Paediatric Neurology, Erasmus MC/ Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Children with low-grade tectal tumors often experience lasting cognitive and behavioral issues. Persistent hydrocephalus significantly impacts their learning and may contribute to symptoms previously attributed solely to cerebellar damage.
Area of Science:
- Pediatric Neuro-oncology
- Neuropsychology
- Hydrocephalus Research
Background:
- Neuropsychological deficits are common after pediatric brain tumor treatment.
- The specific role of hydrocephalus in these deficits remains unclear.
Purpose of the Study:
- To investigate long-term neurological, cognitive, and behavioral deficits in children with low-grade tectal tumors and obstructive hydrocephalus.
- To identify factors influencing cognitive outcomes in this patient group.
Main Methods:
- Prospective collection of neurological, neuropsychological, and radiological data from 12 children with low-grade tectal tumors.
- Assessment of intelligence, memory, attention, language, visual-spatial, and executive functions.
- Median follow-up duration of 2 years and 9 months.
Main Results:
- Fatigue was the most frequent neurological disability.
- Children exhibited lower scores in sustained attention and long-term memory, with increased behavioral problems.
- Persistent severe hydrocephalus was linked to poorer cognitive function.
- 60% of children required special educational services due to cognitive impairments.
Conclusions:
- Children with low-grade tectal tumors experience significant, long-term neuropsychological impairments leading to educational challenges.
- Effective management of hydrocephalus may improve cognitive outcomes.
- Symptoms associated with the cerebellar cognitive affective syndrome might stem from hydrocephalus-induced cerebral dysfunction or compression, rather than solely cerebellar lesions.
Background:
Neuropsychological deficits after treatment of paediatric brain tumour are well known, but not the role of hydrocephalus in these deficits.
Aims:
To study long-term neurological, cognitive, and behavioural deficits in children with a low grade tectal tumour and acquired obstructive hydrocephalus.
Methods:
In a consecutive series of 12 children with low-grade tectal tumour diagnosed in our hospital between 1994 and 2008, neurologic, neuropsychological, and radiologic data were prospectively collected. Intelligence, memory, attention, language, visual-spatial, and executive functions were assessed. Median follow-up was 2 years and 9 months.
Results:
At follow-up, most frequent neurologic disability was fatigue in children with a low-grade tectal tumour. They scored lower on sustained attention, long-term memory and had more behavioural problems. Factor influencing cognition was persisting severe hydrocephalus at time of assessment. The cognitive problems resulted in 60% of children needing assistances of special services at school.
Conclusions:
At long-term, children with a low-grade tectal tumour display invalidating neuropsychological impairments resulting in educational problems. Adequate treatment of hydrocephalus may result in better cognitive functioning. Our findings suggest that part of the symptoms of the cerebellar cognitive affective syndrome may not have resulted from a cerebellar lesion itself but rather from a cerebral dysfunction or compression of supratentorial structures in the cerebello-cortical circuitry due to the obstructive hydrocephalus.
