Aarsen Femke K, Arts Willem F M, Van Veelen-Vincent Marie L C, Lequin Maarten H, Catsman-Berrevoets Coriene E
Department of Paediatric Neurology, Erasmus MC/ Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Paediatric Neurology, Erasmus MC/ Sophia Children's Hospital, Rotterdam, The Netherlands.
Eur J Paediatr Neurol. 2014 Jul;18(4):469-74. doi: 10.1016/j.ejpn.2014.03.002. Epub 2014 Mar 12.
Neuropsychological deficits after treatment of paediatric brain tumour are well known, but not the role of hydrocephalus in these deficits.
To study long-term neurological, cognitive, and behavioural deficits in children with a low grade tectal tumour and acquired obstructive hydrocephalus.
In a consecutive series of 12 children with low-grade tectal tumour diagnosed in our hospital between 1994 and 2008, neurologic, neuropsychological, and radiologic data were prospectively collected. Intelligence, memory, attention, language, visual-spatial, and executive functions were assessed. Median follow-up was 2 years and 9 months.
At follow-up, most frequent neurologic disability was fatigue in children with a low-grade tectal tumour. They scored lower on sustained attention, long-term memory and had more behavioural problems. Factor influencing cognition was persisting severe hydrocephalus at time of assessment. The cognitive problems resulted in 60% of children needing assistances of special services at school.
At long-term, children with a low-grade tectal tumour display invalidating neuropsychological impairments resulting in educational problems. Adequate treatment of hydrocephalus may result in better cognitive functioning. Our findings suggest that part of the symptoms of the cerebellar cognitive affective syndrome may not have resulted from a cerebellar lesion itself but rather from a cerebral dysfunction or compression of supratentorial structures in the cerebello-cortical circuitry due to the obstructive hydrocephalus.
小儿脑肿瘤治疗后的神经心理缺陷是众所周知的，但脑积水在这些缺陷中的作用尚不清楚。
研究患有低度顶盖肿瘤并获得性梗阻性脑积水的儿童的长期神经、认知和行为缺陷。
在1994年至2008年间我院连续诊断的12例低度顶盖肿瘤患儿中，前瞻性收集神经、神经心理和放射学数据。评估智力、记忆、注意力、语言、视觉空间和执行功能。中位随访时间为2年9个月。
随访时，低度顶盖肿瘤患儿最常见的神经功能障碍是疲劳。他们在持续注意力、长期记忆方面得分较低，且有更多行为问题。影响认知的因素是评估时持续存在的严重脑积水。认知问题导致60%的儿童在学校需要特殊服务的帮助。
长期来看，低度顶盖肿瘤患儿存在导致教育问题的无效神经心理损伤。适当治疗脑积水可能会改善认知功能。我们的研究结果表明，小脑认知情感综合征的部分症状可能并非由小脑病变本身引起，而是由于梗阻性脑积水导致大脑功能障碍或小脑-皮质回路中幕上结构受压所致。
