Hydrocephalus
Intro
Brain tumours
Causes
Clinical features
Investigations
Tx
Dilation of ventricular system
Non-communicating (Obstructive)
Communicating (Resorption failure)
congenital malformation
aqueduct stenosis
Dandy-Walker mallformation
atresia of outflow of 4th ventricle
Chiari malformation
brain tissue extends into spinal canal
Post fossa neoplasm / vasc malformation
IVH in premies (PHH)
SAH
meningitis
infants
skull sutures have not fused so increased HC, disproportionately large, excessive rate of growth
skull sutures separate
ant fontanelle bulges
scalp veins become distended
advanced: sun setting eyes (fixed downwards)
older children develop signs + sx of increased ICP
may be dxed on antenatal US
CRUSS
CT/MRI
HC monitored on centile charts
aims: sx relief + minimise risk of neuro damage
VP shunt
commonest
sufficient length of tubing left in peritoneal cavity to allow for child's growth
right atrial catheter
uncommon
require revision with growth
ventriculostomy (endoscopic tx) now available
comps
blockage
infection (coag -ve staph)
overdrainage
can cause low pressure headaches
insertional of regulatory valve can help avoid this
unlike adults, in kids almost all are primary
60% are infratentorial
most common solid tumour in children
types
astrocytoma (60%) - varies from benign to malignant (GBM)
medulloblastoma (20%)
arises in midline of post fossa
may seed in CSF - 20% have spine mets @ dx
ependymoma (8%) - most in post fossa where it behaves like medulloblastoma
clinical features
brainstem glioma (6%)
craniopharyngioma (4%)
arises from squamous remnant of Rathke pouch (gives rise to ant pit)
not truly malignant but locally invasive
grows slowly in suprasellar region
raised ICP
focal neuro signs
if spine involved - back pain, peripheral weakness if arms/legs, bladder/bowel dysfunction
investigations
MRI = best
magnetic resonance spectroscopy can examine biological activity of tumour
no LP if raised ICP
Tx
surgery
tx hydrocephalus
provide tissue dx
attempt max resection
not always possible due to anatomic position (e.g. brainstem)
radio + chemo depends on tumour type + child's age
late effects
neuro disability
growth/endocrine problems
psych effects
education problems