Paediatric Brain Tumour

The surgical removal of a brain tumour is the most beneficial option for patients. The surgeon tries to remove the tumour as much as possible without injuring brain parts.

• Craniotomy- Conventionally, neurosurgeons open the skull by this procedure to remove the tumour. Compared to adults, surgeries in children involve higher precision when it comes to the openings made in the skull. This is also to exercise high vigilance and caution about blood loss.
• Stereotactic surgical biopsy- It is sometimes performed to help diagnose the tumour. A small sample of tissue is obtained and sent for histopathological evaluation.
• Surgical navigation systems- help the surgeon to a precise opening for the tumour excision. It also guides intraoperatively for complete tumour removal.

Ventriculoperitoneal shunting and Endoscopic Third Ventriculostomy

What is CSF?
Cerebrospinal fluid (CSF) is a fluid found within the brain and spine that circulates in the system continuously. Suppose there is a block in circulation due to the mass effect of the tumour. In that case, the ventricles (the cavity containing CSF) enlarge, increasing the pressure within the skull leading to a condition called Hydrocephalus.

Ventriculoperitoneal Shunting and Endoscopic Third Ventriculostomy can treat Hydrocephalus.

• Ventriculoperitoneal Shunting – The neurosurgeon uses a shunt to divert the CSF, causing the pressure to build up in the skull. The fluid is drained through the shunt into the peritoneal cavity (the cavity housing the abdominal organs), which helps reduce the pressure.
• Endoscopic Third Ventriculostomy- The neurosurgeon uses this procedure to divert the brain fluid around the obstruction without needing a shunt.

Radiation therapy uses high-energy X-rays or particles to kill cancer cells and abnormal brain cells, which helps control the brain’s malignant tumours. It is usually recommended after surgery to improve the treatment results.

• High precision techniques like Intensity Modulated Radiotherapy (IMRT),
  Image-guided Radiotherapy (IGRT) and Volumetric Modulated Arc Therapy (VMAT/RapidArc) are useful in targeting the tumour accurately and avoiding normal tissue injury.
• Tomotherapy combines intensity-modulated radiation delivered with the precision and accuracy of computed tomography scanning technology.
• Proton Beam Therapy is ideally suited to treat brain tumours and is the global benchmark of excellence in treating paediatric brain tumours. The tumour’s proximity to delicate and vitally important tissues and structures makes absolute accuracy imperative. With the characteristics of Proton beams, these structures are maximally spared, thus minimising long-term effects of radiation therapy.
• Stereotactic Radiosurgery (SRS) is a special radiation technique that delivers precisely-targeted high-dose radiation therapy in fewer sessions than traditional radiation therapy, in fewer sessions. This helps preserve healthy brain tissue.

• Chemotherapy

  Chemotherapy uses cytotoxic drugs to destroy fast-growing cells, such as cancer cells. Generally, these drugs are given in combination every 4 to 6 weeks to a maximum of 6 cycles. Sometimes, if one drug regimen stops working for the tumour, another drug or a combination (2nd line). Blood tests are recommended to check your parameters before the start of each cycle of chemotherapy.

• Targeted drug therapy
  
  Targeted therapy focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
• Rehabilitation after treatment

  Because brain tumours can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Rehabilitation may include:

  • Physical therapy to help the child regain lost motor skills or muscle strength

  • Occupational therapy to help the child get back to daily activities

  • Speech therapy if the child has difficulty speaking

  • Tutoring if the child needs help to cope with changes in memory and thinking after treatment.