Neuroophthalmic Manifestations of Intracranial Tumours in Children

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.

SURG-12. PAEDIATRIC BRAIN TUMOUR SURGERY: HOW CAN WE REPORT OUR SURGICAL OUTCOMES AND OPERATIVE MORBIDITY?

OBJECTIVE Our objective was to quantify resection outcomes and operative morbidity in paediatric brain tumour surgery using existing scales, assessing their applicability. METHODS We investigated morbidity using the Clavien-Dindo (CD) scale and the Drake classification. All paediatric patients receiving a biopsy or craniotomy for an intracranial tumour in a single tertiary paediatric neurosurgery centre between January 2008 and December 2018 were studied. Complications up to day 30 post op were graded. RESULTS There were 459 operations: 92 biopsies and 367 craniotomies comprising 166 infratentorial and 292 supratentorial tumours. Median age was 9 years (56% male). The surgical goal was achieved or exceeded in 94% of cases. Thirty-day mortality was 1.31% with all deaths related to disease and none to surgical complications. The overall CD score was 1 in 10.9% of cases, 2 in 18.9%, 3A in 1.7%, 3B in 11.8%, and 4 in 1.1%. There was no operative morbidity in 54% of cases. Using the Drake classification, meningitis was seen in 3.92% of cases, seizures in 3.92%, neurological deficit (that persisted at 30 days) in 8.5%, CSF leak in 5.01%, wound infection in 1.96%, haemorrhage 1.75 %, shunt infection in 1.53%, shunt block in 0.65%, medical complications in 2.4%, and others in 3.05%. CONCLUSIONS This is the largest series presenting morbidity from paediatric brain tumour surgery, and the first to validate the CD scale. Our morbidity on the Drake scale was comparable with other series. There is a need to develop improved tools to quantify morbidity in this high-risk specialty.

Study of Supratentorial Tumours by Computed Tomography

Background: Brain neoplasms may be classified by the location of supratentorial, infratentorial and midline tumours. Of the supratentorial neoplasms, meningiomas are the most frequent extra-axial neoplasms. CT has become the most important diagnostic procedure in evaluating patients suspected of harboring an intracranial tumor. It is still considered the basic radiologic study since it gives specific information for the management of brain tumours and is minimally invasive. The purpose of this study was to assess the distribution, features, localization and extent of supratentorial neoplasms. Subjects and Methods: Fifty cases with symptoms of intracranial pathology and on CT found to have supratentorial tumours were studied. Results: The CT patterns of 50 supratentorial tumours were reviewed, out of which 30 cases i.e. 60%, were found to be intra- axial and 20 i.e. 40% extra-axial tumours. GBM formed the major group of the intra axial tumours i.e. 18 %, and meningiomas formed the major extra-axial tumours forming 26%. Conclusion: CT proves to be a valuable modality of imaging in evaluating the distribution, features, localizing and assessing the extent of various intra and extra-axial tumours in the supratentorial region.

Assessment of heart rate variability during different propofol effect site concentrations in patients with supratentorial tumours: A pilot study

Background: Impaired autonomic function (AF) can result in adverse cardiovascular events during the perioperative period. Literature suggests that patients with intracranial space-occupying lesions experience impaired AF depending on the site of tumour and associated raised intracranial pressure (ICP). The complex interaction between general anaesthetics, AF and intracranial tumours with raised ICP has not been extensively studied. Objective: This study was aimed at evaluating the cardiac AF (in terms of heart rate variability [HRV]) in patients undergoing surgery for supratentorial tumours, at baseline and at different propofol effect site concentrations (Ce) during anaesthetic induction and the results were compared with patients undergoing non-cranial surgeries. Materials and Methods: In this prospective observational study, consecutive adult patients undergoing surgeries for supratentorial tumour (study group) and brachial plexus injury (control group) were recruited. Electrocardiogram was recorded for 5 min at three time points – before propofol induction, at propofol Ce 2 μg/ml and at Ce 4 μg/ml. Results: Forty-five patients were recruited, 24 in study group and 21 in control group. In spite of similar baseline heart rate and blood pressure, low frequency (LF), high frequency (HF) and total power were significantly higher in control group. Baseline LF/HF, though higher in patients with intracranial tumour (craniotomy: 2.2 ± 2.2, control: 1.2 ± 1.1), was not significantly different between the two groups (P = 0.197). HRV variables in both the groups changed the same way in response to the increasing propofol Ce. Conclusion: HRV measurements were significantly different at baseline between the two groups. Following propofol administration, haemodynamic changes and HRV changes were similar in both the groups and also between the two groups.