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Neuroophthalmic Manifestations of Intracranial Tumours in Children
Megha Kotecha1, Sarang Gotecha2, Ashish Chugh2
1Department of Ophthalmology, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.
Insights
Pediatric brain tumors present with varied neuroophthalmic and clinical signs. Early detection is crucial, as ocular symptoms like vision loss, double vision, and strabismus can indicate serious intracranial space-occupying lesions.
Area of Science:
- Pediatric Neuro-oncology
- Neuro-ophthalmology
- Pediatric Neurosurgery
Background:
- Study included children aged 0-16 years with surgically treated brain tumors confirmed by MRI.
- Focus on evaluating neuroophthalmic and clinical features of pediatric intracranial space-occupying lesions.
Observation:
- Neuroophthalmic manifestations, tumor location (contrast-enhanced MRI), surgical intervention, and histopathology were analyzed.
- Male predominance observed in pediatric brain tumors.
- Supratentorial tumors common overall, but infratentorial tumors more frequent in older children.
Findings:
- Common neurological features: headache, vomiting, cerebellar signs. Common ophthalmic symptoms: vision loss, diplopia, strabismus.
- Frequent ophthalmological signs: papilledema, ophthalmoparesis, nystagmus.
- Supratentorial tumors associated with seizures, altered sensorium, motor deficits; infratentorial tumors with cranial nerve involvement, ataxia, and ophthalmological signs.
- Astrocytoma and medulloblastoma were the most common histopathological diagnoses.
Implications:
- Diagnosis of pediatric brain tumors is complex, necessitating a multidisciplinary approach.
- Ophthalmologists should maintain a high suspicion for brain tumors in children presenting with ocular symptoms, even without overt neurological signs.
Background:
All children between 0 and 16 years presenting with brain tumours confirmed by Magnetic Resonance Imaging (MRI) and treated surgically in our institute were included in this study.
Objective:
The aim of this study is to evaluate the neuroophthalmic and clinical characteristics of intracranial space occupying lesions in children.
Methods:
Neuroophthalmic manifestations along with location of the tumour by contrast-enhanced MRI, type of surgical intervention, and postoperative histopathological diagnosis were evaluated.
Results:
In pediatric brain tumours, male preponderance was seen and supratentorial location was more common in general, while in older children, infratentorial tumours were more common than supratentorial tumours. Headache, vomiting, and cerebellar signs were the commonest neurological features. Diminution of vision, diplopia, and strabismus were the commonest ophthalmic symptoms. Papilledema, ophthalmoparesis, and nystagmus were the most frequent ophthalmological signs. Neurological manifestations of seizures, altered sensorium and motor deficits were more frequently seen in supratentorial tumours, while cranial nerve involvement and ataxia were seen in infratentorial tumours. Ophthalmological manifestations including diplopia, strabismus, ophthalmoparesis, and nystagmus were more frequently seen in infratentorial tumours. Astrocytoma was the most frequent histopathological diagnosis followed by medulloblastoma.
Conclusion:
Diagnosis of pediatric intracranial tumours is complex and requires a multidisciplinary approach for prompt management. An ophthalmologist should have a high index of suspicion for brain tumours especially in patients presenting with common ocular symptoms like diminution of vision, diplopia, and strabismus without any neurological symptoms.
