gms | German Medical Science

Objective: Recent advances in the treatment of children with brain tumors resulted in better chances for longer survival. Still open questions refer to possible late sequelae and also to the care for the patients after their transition into the adult age. We present the course of four meanwhile adult patients where different kinds of impairment are noted.

Methods: Courses of treatment and disease in three girls and one boy with brain tumors treated in childhood who are now above 18 years of age are reviewed. All patients are still in the care of our department and were examined only recently so follow up is complete. Clinical, radiological and treatment data were collected.

Results: One boy had a chorioid plexus carcinoma in the right ventricle operated first in 1997 at the age of 4 months. The patient has no recurrence of the tumor now at the age of 19 years. Severe psychological impairment requiring psychological treatment started in 2013 and makes follow up examinations nearly impossible at present. One girl was operated for a cerebellar medulloblastoma at the age of 2 years in 1985. She now developed a glioblastoma in the posterior fossa at the age of 33 years. Severe physical retardation is noted, too. Another girl was treated for a cerebellar medulloblastoma at the age of 4 years in 1987. No recurrence of the tumor is seen. Severe retardation is noted as well as ischemic neurological deficits due to vascular fibrosis possibly after radiation. A huge myoma in the uterus was noted, too.One girl was operated for an ependymoma of the posterior fossa at the age of 3 years in 1996. No recurrence is seen but now a tumor in the left frontal lobe is developing which may turn out to be a meningioma. All patients received chemotherapy and three patients had radiation at different ages.

Conclusion: The mean prognosis for long-term survival longer than 10 years is observed in 71 % of children with a brain tumor. Late complications and secondary tumors may occur. They may cause a new and progressive physical and psychological impairment. This may occur even late in life (in one patient of our group a secondary tumor was seen at the age of 33 years). So a life-long care and a close clinical, radiological and neurological follow up seem necessary. These findings underline the importance of the neurosurgeon in this network: he is still caring and responsible for the patient even after the pediatrician is no longer involved.