Background: Brain tumours constitute the second most common tumours in childhood after leukaemia. Infra-tentorial tumours are more common. Most of the supra-tentorial tumours (STT) are in the supra or para-sellar regions. Malignant tumours are rare. The survival is 5090% with appropriate management. However, STT and/or treatment may lead to traumatic brain injury (TBI) with endocrinopathic sequel.
Methods: This is a retrospective hospital based study of 32 children with STT reviewed at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia (SA) (20012013). All patients underwent intracranial surgery and occasionally additional treatment such as radiotherapy. The patients care has been followed throughout.
Results: 32 children (1.517 years) (mean and median=9.5, males=females) with STT were assessed at KKUH. Symptoms include: 68.8% headache, 43.8% vomiting, 37.5% clumsiness, 43.8% for each of neurological deficit and visual disturbances, 28.1% (n=9/32) with pituitary-hypothalamic features. Preoperative imaging showed SST, 21.9% had hydrocephalus, and calcification. Preoperative endocrine investigations were only performed in 5060% and were essentially normal. Five patients had dynamic tests: (triple tests, n=4) (two failed all of the tests and one had a failed synacthen test). Post operatively, seven had DI, one required on table DDAVP and hyperglycaemia requiring insulin in one patient. 20 patients received dexamethasone for 37 days, four were discharged on hydrocortisone. PICU stay was for 13 days on average. Histopathology showed variety of tumours including: two teratoid rhabdoid tumour, six gliomas, six astrocytoma, four carniopharyngioma and three germinoma. 12 patients required radiotherapy including two who also required chemotherapy. Follow up reveiled two patients with evolving panhypopituitarism, and one developed hyperprolactinaemia and DM within 2 years of follow up.
Conclusion: Children with STT are prone to develop TBI at all stages of their illness and management. It is crucial to have a multidisciplinary team approach with baseline and follow up endocrine workup.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology