| dc.description.abstract | Background: Intracranial brain tumor in children is a rare but severe diagnosis. In children under the age of 15, it covers 1/3 of all cancers. The symptomatology is complex and the time to diagnosis can often be prolonged as the symptoms may mimic other less severe conditions in children. Misinterpretations can lead to a prolonged diagnostic delay time (DDT) and affect the prognosis. A study done in Britain showed that it did exist a prolonged DDT, which initiated the Head Smart campaign. The purpose of our study was to discover if the same delay was present in Norway, and to look at the symptomatology in these children. As younger children often have a different clinical presentation, a topic less immersed in earlier literature, this review is concerning children below five years of age.
Methods: The study is done as a retrospective consecutive study of the children below five years of age present in the protocol of surgery at the neurosurgical department at Oslo University Hospital, Rikshospitalet in the period from 2005 through 2011. In total 70 patients primarily treated for intracranial brain tumor in the infra- and supratentorial compartment were included. Information was systematically gathered from the electronic journal system.
Results: In the material, there were 36 girls and 34 boys. Twenty-one children were diagnosed in their first year of life, 13 in their second, 13 in their third, 11 in their fourth and 12 in their fifth. Forty-six of the tumors were supratentorial and 24 were infratentorial. In the first year of life, 90% had a supratentorial tumor. Twenty-five were high-grade tumors, PNET being most frequent, 45 were low-grade, astrocytomas being most frequent. The five-year overall survival was 90% among the low-grade tumors and 58% among the high-grade ones. The median DDT was 8,1 weeks among the low-grade tumors and 4,5 weeks among the high-grade ones. Distribution of symptoms were: nausea and vomiting (57%), unsteadiness and poor coordination (36%), headache (30%), decreased general state (27%), seizures (24%), decreased well-being (17%), altered level of consciousness (13%), other symptoms (3%). Distribution of signs were: Abnormal eye movements (27%), other neurological signs (19%), macrocephaly (17%), bulging of the fontanelle and splayed sutures (17%), squint (16%), cranial nerve palsy (14%), paretic limbs and focal motor weakness (11%), reduced visual aquity (10%), other signs (10%), head tilt (9%), other visual/eye related signs (9%), no eye contact (7%), nutritional problems (3%).
Conclusion: Brain tumor in children below the age of five gives a heterogenous clinical picture with a wide range of symptoms. The DDT among these 70 patients is at level with the rest of Europe and not prolonged as seen in the UK. | eng |