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Prognosis of the central nervous system

Cerebellar astrocytomas

Five year, ten year, and twenty year survival for these patients is 90%, 87%, and 85%, respectively. Total extirpation of the tumor is a favorable prognostic factor. Most long term survivors live with a well-functioning result after surgery. 

Clinical example

 
Pre and postoperative MRI of fourteen-year-old boy with pilocystic astrocytoma.
  • Fouteen-year-old boy with four months of increasing dizziness, nausea and vomiting. Exam shows papilary edema. 
  • Preoperative MRI shows large expansile tumor in fourth ventricle with supratentorial hydrocephalus and herniation of the foramen magnum . Suspected pilocystic astrocytoma. 
    • Sagittal MRI 
    • Coronal MRI 
    • Axial MRI 
  • Postoperative MRI confirming that the tumor is removed, herniation in the foramen magnum is abolished, and ventricle expansion is less prominent. 
    • Sagittal MRI 
    • Coronal MRI 
    • Axial MRI   
  • Good clinical result after three years. 

Medulloblastoma

Five year and ten year survival with therapy are 54% and 45%, respectively.

Clinical example

 
Pre- and postoperative MRI of eight-year-old boy with medulloblastoma.
  • Eight-year-old boy with increasing headache for four weeks, especially in the morning.
  • Preoperative sagittal and coronal MRI shows large contrast-enhanced tumor in the fourth ventricle. Medulloblastoma suspected.
    • Sagital MRI
    • Coronal MRI
  • Postoperative MRI without sign of remaining tumor.
    • Sagittal MRI
    • Coronal MRI
  • After treatment with radiation and chemotherapy, positive result without recurrence.

Ependymomas

In a Norwegian study, five and ten year survival was both 28%. In Denmark, almost corresponding figures have been reported. Many reports with survival data for this relatively rare disease are based on retrospective cases. These results cannot therefore be directly compared to the Norwegian and Danish figures which are based on all tumors in a defined population.  

Clinical example

 
Pre and postoperative MRI of one-year-old girl with anaplastic ependymoma.
  • One-year-old girl. Treated for dehydration. Continued increased vomiting and lethargy.
  • Preoperative MRI showing contrast-enhanced tumor in the posterior cranial fossa and foramen magnum and accompanying hydrocephalus. Anaplastic ependymoma.
    • Sagittal MRI
    • Coronal MRI
    • Axial MRI
  • Postoperative MRI without sign of remaining tumor.
    • Sagittal MRI
    • Coronal MRI
    • Axial MRI
  • Postoperative chemotherapy well tolerated. Thus far, no sign of remaining tumor or recurrence after almost five years.

Craniopharyngiomas

Craniopharyngeomas in children are often more aggressive than in adults. Long term survival is high (80-90%), but long term effects can be severe and most require hormone replacement. Many have some degree of vision problems due to the location of the tumor close to the optic tracts.

Clinical example

 
Pre and postoperative MRI of five-year-old boy with craniopharyngeoma.
  • Five-year-old boy. Episodic vomiting for 6 months.
  • Preoperative MRI and CT showing large suprasellar tumor with cysts, partly contrast-enhanced and calcium deposits (CT). Craniopharyngioma suspected.
    • Sagittal MRI
    • Coronal MRI
    • Axial MRI
    • Axial MRI
    • Axial CT
  • Postoperative MRI showing that the tumor is removed.
    • Sagittal MRI
  • Hormone replacement, but otherwise well-functioning. 

Brain stem tumors

This type of tumor has a median survival of less than one year. Radiation can be used as initial therapy. Many patients respond to radiation and gain some good months (sometimes more than a year) before the disease progresses. Cure is not realistic.

Optic chiasm/hypothalamus gliomas

Some of these children are able to live with the tumor without visual disturbances and with good function for decades, while others only live a few years due to rapid tumor progression. 

Optic chiasm/hypothalamus gliomas in the setting of neurofibromatosis have a better prognosis than in children without neurofibromatosis.

Clinical example

 
Pre and postoperative MRI of 4-year-old girl with exophytic optic tract glioma (pilocystic astrocytoma).
  • Four-year-old girl with precocious puberty (breast development, pubic hair) and reduced vision.
  • Preoperative MRI shows a large, partly contrast-enhanced suprasellar tumor.
    • Sagittal MRI
    • Axial MRI
  • During the operation, an exophytic optic tract glioma was found (pilocystic astrocytoma) that was partly removed. Postoperative MRI showing status after surgery.
    • Sagital MRI
    • Axial MRI
  • She gets hormonal therapy and has good vision in half of the vision field of the left eye. Stable after four year observation.  

Tumors in the pineal gland region

The most common tumors in this region are germ cell tumors with histological variation corresponding to testicular cancer. Germinomas (seminomas) constitute about 50% and over 90% of these patients are cured. The prognosis for nonseminoma tumors is poorer.

Hemisphere tumors

The prognosis for tumors in the cerebrum is better than for tumors in the posterior cranial fossa because only about 25% of them are highly malignant, in contrast to about half of posterior cranial fossa tumors.

Meningiomas

The prognosis in non neurofibromatosis patients is very good with relatively rare recurrences.

Choroid plexus papillomas

These tumors constitute about 5% of intracranial tumors. The majority are papillomas with a very good prognosis when the tumor is removed. The tumors are highly vascularized and interoperative bleeding can be a problem. A small number of these tumors are histologically malignant and are called choriod plexus carcinomas, which have a more uncertain prognosis. These are often treated with chemotherapy and radiation.

Clinical example

 
Pre and postoperative MRI of four-month-old boy with plexus papilloma.
  • Four-month-old boy with dramatic increase of head circumference discovered by public health clinic. Large, taut head with enhanced vein patterns.
  • Preoperative MRI showing typical contrast-enhanced plexus papilloma in third ventricle and prominent hydrocephalus.  
    • Sagittal MRI
    • Coronal MRI
    • Axial MRI
  • Postoperative MRI showing the tumor is removed.
    • Sagittal MRI
    • Coronal MRI
    • Axial MRI
  • Good clinical development. 

 

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