Long term neuropsychological outcomes of a pediatric ETANTR brain tumor: A case study
Tina Thomas1, Julie A Grieco1, Margaret Pulsifer1
1Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Pediatric brain tumor survivors can show resilience, but often face lasting executive functioning challenges. This case study highlights factors contributing to a favorable outcome despite a rare frontal tumor (ETANTR).
Area of Science:
- Neuroscience
- Pediatric Oncology
- Psychology
Background:
- Survivors of pediatric brain tumors frequently experience long-term neuropsychological deficits.
- Embryonal tumor with abundant neuropil and true rosettes (ETANTR) is a rare, aggressive brain tumor associated with poor prognosis and significant neurological impact.
- Frontal lobe tumors in children can severely impact cognitive development during critical growth periods.
Purpose of the Study:
- To present longitudinal neuropsychological data over 10 years for a patient with a rare bifrontal ETANTR.
- To identify patient characteristics and protective factors associated with neuropsychological outcomes in pediatric brain tumor survivors.
- To inform targeted interventions for executive and adaptive functioning deficits in this population.
Main Methods:
- Longitudinal case study design.
- Neuropsychological assessment spanning 10 years (ages 9-19).
- Analysis of tumor characteristics, treatment history, and patient protective factors.
Main Results:
- The patient demonstrated largely intact cognitive functioning.
- Specific deficits were noted in executive functioning, fine motor skills, and adaptive functioning.
- Resilience was observed despite a large tumor, multi-modal treatment, and seizure history, supported by high cognitive reserve and educational services.
Conclusions:
- Favorable neuropsychological outcomes in pediatric brain tumor survivors are influenced by protective factors like cognitive reserve and support systems.
- Early diagnosis and treatment during critical developmental periods for higher-order cognition can impact executive and adaptive skills.
- Pediatric brain tumor survivors, particularly those with ETANTR or frontal tumors, require specialized screening and interventions for executive functions.
Abstract:
Survivors of pediatric brain tumors are at high risk for long-term neuropsychological difficulties. In the current case study, we present longitudinal neuropsychological data spanning 10 years (from age 9 to 19 years) of a patient with a rare, very large, bifrontal, embryonal tumor with abundant neuropil and true rosettes (ETANTR), which is typically associated with poor survivorship and significant neurological impact. Results demonstrated that the patient had largely intact cognitive functioning with specific difficulties in executive functioning, fine motor skills, and adaptive functioning at her most recent neuropsychology 10-year follow-up. These results highlight outcomes for a patient with remarkable resiliency in the context of numerous risk factors (a very large tumor size, multi-modal treatment, and seizure history). Patient protective factors (a high level of cognitive reserve, family support, and appropriate comprehensive educational services) likely contributed to the patient's favorable neuropsychological outcome. The patient's age at brain tumor diagnosis (9 years) and associated treatment was at a critical period of development for emerging higher order cognitive functions which likely impacted acquisition of executive functioning skills and secondarily adaptive skill outcomes. Consequently, pediatric brain tumor survivors with ETANTR or other frontal tumors require targeted screening of executive functions and proactive interventions.
