Pediatric brain tumors: diagnosis and management

Pediatric brain tumors are the most common solid tumor and the second most common neoplasm in childhood. Confirmation of diagnosis is made by visualization of the tumor on a computed tomographic or magnetic resonance imaging scan. Treatment includes surgery followed by observation or chemotherapy and/or radiation therapy, depending on the amount of tumor removed and its histological characteristics. Recent advances in neuroradiology, neurosurgical techniques, and neuro-oncology have begun to impact the length and quality of survival of children diagnosed with brain tumors. A multidisciplinary approach in the treatment of these children is necessary with the nurses and/or nurse practitioners as the consistent members of the team often coordinating the care.

The role of stereotactic radiation therapy in the management of children with brain tumors

Conventional radiation therapy plays an important role in the management of intracranial tumors in children. For certain tumors radiation therapy serves as the primary mode of treatment, and for others it plays an adjuvant role with surgery and/or chemotherapy. Improvements in long-term survival rates have focused attention on the long-term sequelae of brain tumors and their treatment, and the sequelae, in turn, have become important targets for clinical investigation. Long-term side effects of particular concern in children include cranial nerve damage, memory and intellectual deficits, pituitary-hypothalamic dysfunction, demyelinization of brain tissue, and secondary malignancies. A new form of radiation therapy, stereotactic radiotherapy (SRT), merges the technologies of stereotactic surgery and conventional fractionated radiotherapy. The intent is to deliver maximum tumoricidal doses to the target while limiting the dose to normal surrounding brain tissue. The key feature of SRT is a noninvasive, relocatable immobilization system to assure accurate and reproducible positioning during planning and treatment. The headframes used for children have been modified to address their specific needs. The complexities of this process require careful preparation of patients and their families and the participation of many disciplines. Long-term follow-up will be essential to evaluate the effectiveness of this innovative treatment.

Contemporary approaches of chemotherapy

This article discusses recent chemotherapeutic therapies for patients with malignant glioma. The use of biodegradable polymer wafers, chemical alteration of the blood-brain barrier, high-dose hormonal therapy, and bone marrow transplantation are included as new approaches to treatment. The use of growth factors and improved antiemitics allow patients to tolerate aggressive chemotherapy.

Interactive, image-guided, stereotactic neurosurgery systems

Interactive, image-guided, stereotactic neurosurgery systems and advanced computer programs enable neurosurgery teams to use magnetic resonance imaging (MRI) and computed tomography (CT) scans to perform less-invasive intracranial tumor excisions. This new methodology, also known as frameless stereotactic neurosurgery, provides accurate, precise preoperative and intraoperative patient information to neurosurgeons. Neurosurgeons use a pointing device to communicate surgical locations quickly to a computer system. The computer then provides immediate, three-dimensional displays of pertinent MRI and CT scan information on the monitor. These intracranial images serve as navigational guides to neurosurgeons before and during surgical intervention. Interactive, image-guided, stereotactic neurosurgery systems, however, are only surgical tools, not substitutes for health care providers' knowledge or expertise. Neurosurgeons must balance their medical judgment with interpretations of computer-generated information throughout the surgical procedures. Interactive, image-guided systems should not interfere with patient care priorities but rather should be worked into the intraoperative nursing routine.

Development and preliminary testing of the neurological assessment instrument

The purpose of this study was to test a neurological assessment instrument (NAI), used to assess neurological function in adults with acute brain lesions. Instrument items were designed to reflect different aspects of neurological function and assess consciousness along the arousal/awareness continuum as described by Plum and Posner. Content of the NAI was validated by 10 neuroscience expert physicians, nurses and speech pathologists. Reliability was tested with one pair of raters on 39 neurologically stable patients with acute brain lesions. Based on preliminary findings, the critical preliminary steps have been taken towards establishing a reliable and valid instrument with the potential of improving the assessment of neurological function in patients with acute brain lesions.

Length of hospital stay and contributing variables in supratentorial craniotomy patients with brain tumour: a pre-care map study

The study included 70 patients admitted to Neurosurgical ICU (NICU) with the diagnosis of Supratentorial Craniotomy for Brain Tumour. These patients were followed throughout their hospitalization in NICU, to the ward and until discharge from hospital. The purposes of the study were (a) to indicated the NICU and floor length of stay (LOS) in this group of patients, prior to the use of care map and compare it to a developed care map, and (b) to identify the variables that contribute toe overall prolonged hospital LOS. The findings indicated that, prior to the use of care map, 68.8% of Supratentorial Craniotomy Patients with Brain Tumour had an ICU LOS of one day. However, only 38.6% of these patients were discharged from hospital within the care map indicated 5 day post ICU, floor LOS. The findings also showed that the overall hospital LOS, in 71.4% of the patients, was over 7 days, as indicated on the developed care cap. Several variables such as patient complications, consults, rehab/placement, patient falls and additional diagnostic tests contributed to the overall pronged hospital LOS. Thus, by monitoring these variables with the use of a care map, may produce measurements to evaluate cost effectiveness, and allow health care professionals to provide more effective and quality patient care.

A place to call home

When 54 year old Lisa was admitted to the Western Division of the Toronto Hospital in November 1987, it was for removal of a benign cranio-cerebral tumor. The pulmonary compromise she had lived with for many years--the result of a congenitally short spine--was accentuated during the months following surgery. With breathing difficulties and recurrent pneumonia, Lisa required assisted ventilation. And though she tolerated being off the ventilator for a total of five hours during the day, repeated attempts to wean her were unsuccessful.

Stereotactic localization and resection of intracranial tumors

Stereotaxis has existed since the early 1900s, originating in Western Europe. Its practice was originally limited to isolation of nerve tracts, drainage of superficial abscesses and early attempts at psychosurgery. Today, with stereotactic-compatible imaging techniques and equipment, many types of intracranial lesions can be precisely localized and resected. Stereotactic approaches to therapy, including aggressive surgical resection, have become the treatments of choice for many types of potentially devastating lesions. A case study illustrates a stereotactic resection procedure, as well as the nursing plan of care and implications for the neuroscience nurse.

Nursing concerns associated with radical skull base surgery: a case study

Historically, surgical management of extensive neoplasms of the cranial base has been limited by anatomical boundaries. However, major theoretical and technological advances now permit radical surgical resections. The perioperative nursing care of these patients is challenging and requires a wealth of knowledge and skills. The complexity of caring for patients undergoing radical skull base surgery is highlighted through a case study.

Psychological care of neuro-oncology patients and their families

This article examines the psychological needs of neuro-oncology patients and their families and presents two case histories which illustrate the way in which patients and their families can be brought to terms with their situations through skilled nursing intervention.

The false localizing signs of increased intracranial pressure

False localizing signs, although rare, indicate significant increased intracranial pressure with tissue shift, has occurred. A review of the historical perspective highlights the discovery of these false localizing signs, and exploration of the anatomic and physiologic causes provides important insight for neuroscience nurses. Critical thinking skills, and a world view paradigm for clinical practice are developed upon an in-depth understanding of neurologic dysfunction. Collaborative relationships are enhanced by an interdisciplinary approach to assessment of the critically ill neuroscience patient.