Brain Tumors.pptx. WHAT CAUSES BRAIN TUMOURS

Brain tumours in children

1. BRAIN TUMORS

2. Most common form of solid tumor second most common type of cancer in children Slightly more than half of brain tumors arise in the posterior fossa (infratentorial); the rest are supratentorial in origin. The cause is idiopathic Some tumors are localized (low grade), while others are of higher grade and more invasive. The prognosis depends on the location of the tumor and extent of tumor

3. Common brain tumors Medulloblastoma Most common Located in cerebellum Invasive,highly malignant,grows rapidly Poor prognosis with disseminated disease Progress quickly to inc ICP Seeds on CNS pathway Affects kids below 6 yrs

4. Brain stem glioma Affect brain stem Aggressive Difficult to resect Resistant to chemo Spreads widely within brain stem ,rarely extend outside brian stem Affects cranial nerve function

5. Ependymona Arise from floor of 4 th ventricle Speed of growth vary Causes hydrocephalus Usually dx b4 mets to brain or spinal cord

6. Astrocytoma Located in cerebellum ,cerebral hemispheres, thalamus and hypothalamus Slow course with insidious onset Responsive to chemo Causes slow incr ICP Low grade tumor may be removed completely Poor prognosis with high grade tumors

7. Pathophysiology Though the cause of brain tumors is generally not known, the effects of brain tumors are predictable. As the tumor grows within the cranium, it exerts pressure on the brain tissues surrounding it. The tumor mass may compress vital structures in the brain, block cerebrospinal fluid flow, or cause edema in the brain. The result is an increase in intracranial pressure. Presenting symptoms vary according to location and type of tumor.

8. Nursing Assessment History taking Elicit common C/M: Nausea or vomiting Headache-worse in the morning Unsteady gait Blurred or double vision Seizures Motor abnormality or hemiparesis

9. Weakness, atrophy Swallowing difficulties Behavior or personality changes Irritability, failure to thrive, or developmental delay (in very young children) Explore the child's history for risk factors: history of neurofibromatosis, tuberous sclerosis, or prior treatment for CNS leukemia

10. PE INSPECTION AND OBSERVATION Observe for strabismus or nystagmus, “sunsetting” eyes, head tilt, alterations in coordination, gait disturbance, or alterations in sensation. Note alteration in gag reflex, cranial nerve palsy, lethargy, or irritability. Note the child's posture. Check pupillary reaction, noting size, equality, reaction to light, and accommodation.

11. PALPATION Measure blood pressure, which may decrease with increasing intracranial pressure. In the infant, palpate the anterior fontanel for bulging. Assess deep tendon reflexes, noting hyperreflexia

12. Lab and Dx tests CT, MRI, or positron emission tomography (PET) will demonstrate evidence of the tumor and its location within the intracranial cavity. LP with CSF cell evaluation may show tumor markers or the presence of α-fetoprotein or human chorionic gonadotropin, which may assist in the diagnosis

13. MGT The type of tumor may be identified at the time of surgery. The location of the tumor within the brain will determine the extent to which it can safely be resected. Children with hydrocephalus may require a ventriculoperitoneal shunt Radiation is reserved for children older than age 2 years because it can have long-term neurocognitive effects Chemotherapy is being used increasingly in the treatment of pediatric brain tumors in an attempt to avoid the use of radiation therapy.

14. CRANIOTOMY :PRE.OP Perform a neurological assessment at least every 4 hours. Institute seizure precautions and safety measures. Monitor incr ICP& avoid activities that inc it Assess weight loss and nutritional status. Shave the child’s head as prescribed Prepare the child as much as possible; tell the child that he or she will wake up with a large head dressing.

15. Give dexa to reduce intracranial inflammation Laxatives to prevent constipation Plan ICU post sx Educate family on shunt

16. POST.OP CARE Assess neurological and motor function and LOC Monitor temperature closely, which may be elevated because of hypothalamus or brainstem involvement during surgery; maintain a cooling blanket by the bedside. M onitor for signs of respiratory infection. Monitor for signs of meningitis ( opisthotonos, Kernig’s and Brudzinski’s signs ). Monitor for signs of increased ICP Check the head dressing for cerebrospinal fluid drainage or bleeding.

17. Assess pupillary response; sluggish, dilated, or unequal pupils are reported immediately because they may indicate increased ICP and potential brainstem herniation. Monitor for colorless drainage on the dressing or from the ears or nose, which indicates CSF and should be reported immediately; assess for the presence of glucose in the drainage (dipstick). Adhere positioning i.e In an infratentorial procedure-flat & lateral In a supratentorial procedure-elevate head to facilitate CSF drainage and to decrease excessive blood flow to the brain to prevent hemorrhage. Trendelenburg’s position is C/I - it increases intracranial pressure and the risk of hemorrhage

18. Monitor intravenous fluids closely. Promote measures that prevent vomiting Provide a quiet environment . Administer analgesics as prescribed Provide emotional support to the child and parents, and promote optimal growth and development. Regulate fluid intake (cerebral edema)

19. Check the head dressing for cerebrospinal fluid drainage or bleeding. Assess for and document the extent of head, face, or neck edema. Administer eye lubricant if edema prevents complete closure of the eyelids. Apply cool compresses to the eyes to decrease swelling

20. Give mannitol Rx hyperthermia Assess pain level & mx

21. Complications hydrocephalus, increased intracranial pressure, brain stem herniation, and negative effects of radiation such as neuropsychological, intellectual, and endocrinologic sequelae NB: Monitor for signs of increased ICP in a child with a brain tumor and after craniotomy .

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