Brain tumours are the second most c o m m o n form of cancer in children. The majority of children treated for brain tumour survive, but they can experience a number of neurological and neuropsychological sequelae. A range of tumour, treatment, and psychosocial factors cumulatively and interactively determine long-term sequelae in these children. There is a paucity of research on neuropsychological outcomes, and the determinants of these outcomes, in children treated for brain tumour with surgery-only. This is because they represent a minority of children treated for brain tumour. Research has focused on children treated with radiotherapy and chemotherapy where the effects can be devastating. The present study examined neuropsychological outcome in children treated with surgery-only to identify risk factors for poor outcome, to determine sequelae according to tumour location, and to explore the process of recovery over a one-year period.

Neuropsychological outcomes in children treated with surgery for brain tumour

This research builds on our hypothesis that white matter damage and associated neurocognitive symptoms, in children treated for cancer with cranial spinal irradiation, spans a continuum of severity that can be reliably probed using non-invasive MR technology. Quantitative volumetric assessments of MR imaging and psychological assessments were obtained in 40 long-term survivors of malignant brain tumors treated with cranial irradiation. Neurocognitive assessments included a test of intellect (Wechsler Intelligence Test for Children, Wechsler Adult Intelligence Scale), attention (Conner's Continuous Performance Test), and memory (California Verbal Learning Test). One-sample t-tests were conducted to evaluate test performance of survivors against age-adjusted scores from the test norms; these analyses revealed significant impairments in all apriori selected measures of intelligence, attention, and memory. Partial correlation analyses were performed to assess the relationships between brain tissues volumes (normal appearing white matter (NAWM), gray matter, and CSF) and neurocognitive function. Global intelligence (r = 0.32, p = 0.05) and global attentional (r = 0.49, p < 0.01) were significantly positively correlated with NAWM volumes, whereas global memory was significantly positively correlated with overall brain parenchyma (r = 0.38, p = 0.04). We conclude that quantitative assessment of MR examinations in survivors of childhood cancer treated with cranial irradiation reveal that loss of NAWM is associated with decreased intellectual and attentional deficits, whereas overall parenchyma loss, as reflected by increased CSF and decreased white matter, is associated with memory-related deficits.

Correlation of neurocognitive function and brain parenchyma volumes in children surviving cancer

Our research builds on the hypothesis that white matter damage, in children treated for cancer with cranial spinal irradiation, spans a continuum of severity that can be reliably probed using non-invasive MR technology and results in potentially debilitating neurological and neuropsychological problems. This longitudinal project focuses on 341 quantitative volumetric MR examinations from 58 children treated for medulloblastoma (MB) with cranial irradiation (CRT) of 35-40 Gy. Quadratic mixed effects models were used to fit changes in tissue volumes (white matter, gray matter, CSF, and cerebral) with time since CRT and age at CRT as covariates. We successfully defined algorithms that are useful in the prediction of brain development among children treated for MB.

Quantitative MR assessment of longitudinal parenchymal changes in children treated for medulloblastoma

Brain tumors in children and adolescents up to 18 years of age

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Brain tumors in children and adolescents up to 18 years of age