it is very useful for nursing students

1. BRAIN TUMOR

2. BRAIN TUMOR
 Brain tumors are expanding lesions within the skull
 20% of childhood malignant tumors are brain tumors
 Benign tumors may be life threating if it is located in
the vital areas of the brain

3. ETIOLOGY
 Unknown
 Family history
Risk factors
 Epstein –Barr virus
 Ionizing radiation
 Inherited syndromes –neurofibromatosis, tuberous sclerosis

4. CLASSIFICATION
(i)Infratentorial tumors –tumors occurs in the area of the
brain below tentorium cerebelli involving cerebellum or
brainstem
(ii) Supratentorial tumors - tumors occurs in the area of
the brain above tentorium cerebelli

5. CLASSIFICATION
(I) Infratentorial tumors
a) Medulloblastoma
b) Cerebellar Astrocytoma
c) Glioma
d) Ependymoma of the fourth ventricle
(II)Supratentorial tumors
a) Craniopharyngioma
b) Hypothalamic glioma
c) Glioma of optic nerve
d) Primitive neuroectodermal tumor/cerebral neuroblastoma

6. PATHOPHYSIOLOGY
Due to etiology
Space occupying lesion
Tumor cell proliferation, enlarging tumor
Cerebral edema Compress brain tissue
Increased ICP Altered blood flow
Herniation of brain Ischemia Necrosis
Neurological deficits
Signs and symptoms depend on the location of the tumor

7. INFRATENTORIAL TUMORS
Medulloblastoma:
These are midline cerebrallar tumors and occurs in
infancy
Fast growing and malignant
Craniospinal spread along with neuraxis is common and
death occurs early.

8. CONT….
Medulloblastoma:…….
Clinical features
• Truncal ataxia
• Early pappiledema
• Unsteadiness in sitting position
 Tendency to walk with a broad base gait
 hydrocephalus
Management
 Radiation
 Chemotherapy
 VP shunt

9. CEREBRAL TUMORS…..
Cerebellar Astrocytoma
 Common in the cerebellar hemisphere
Clinical feature
 Ataxia and incordination are common on the side of lesion
 Nystagmus
 Areflexia and hypotonia
 Head is tilted to the side of the lesion –to relieve the increased
ICP
Management
 Chemotherapy
 Radiation –brachytherapy
 Surgical excision

10. CONT..
BRAIN STEM GLIOMA
• Worst prognosis
• Most child die within 18months
Clinical features
• Gait disturbance
• Headache, nausea, vomiting
• Cranial nerve defecits-diplopia,facial asymmetry
• Papilledema
• Hydrocephalus
• Failure to thrive

11. CONT….
BRAIN STEM GLIOMA……
Management
• Chemotherapy
• Radiation therapy
• Surgical excision
• VP shunt

12. CONT…
Ependymoma of the fourth ventricle:
 Occurs in first decade of life
 Flow of CSF is obstructed leads to increased
intracranial pressure
 Signs of increased ICP
Management
 Surgical excision is rarely possible
 Chemotherapy and radiation therapy
 VP shunt

13. SUPRATENTORIAL TUMORS
Craniopharyngioma:
 It is congenital and arises from squamous epithelial cells of the
embryonic rathke pouch
Clinical features:
• Growth failure
• Bitemporal hemianopsia
• Asymmetric or unilateral visual field defects
• Signs of increased ICP
• Endocrine abnormalities – DI,delayed puberty
Management
• Chemotherapy, Radiation therapy
• Surgical excision is rarely possible

14. SUPRATENTORIAL TUMORS….
Hypothalamic glioma
Clinical features
 Failure to thrive
 Loss of subcutaneous fat
 Sleep disturbance
 Respiratory disturbance
 Older children may have precocious puberty
MANAGEMENT
Radiation therapy
Chemotherapy
Surgical excision(based on size and metastasis)

15. SUPRATENTORIAL TUMORS….
Glioma of optic nerve
Clinical features
 Visual disturbances
 Squint
 Proptosis
 Exophthalmos
 Optic atrophy
MANAGEMENT
 Chemotherapy and radiation therapy
 Surgical excision is possible if the tumor is limited to
one side

16. CONT
 Primitive neuroectodermal tumor/cerebral
neuroblastoma
malignant tumor arise from primitive nerve cells
Clinical features
• Headache,seizures,loss of co-ordination
• Vertigo,diplopia,problems with walking and balance
• Weight loss
• Behavioral changes
MANAGEMENT
• Radiation, chemotherapy
• surgery

17. DIAGNOSTIC EVALUATION
 History collection
 Neurological assessment
 CT
 MRI
 Cerebral angiography
 Biopsy
 LP- contraindicated in elevated ICP

18. NURSING MANAGEMENT
PRE-OPERATIVE
 Monitor vital signs
 Perform neurological assessment
 Measure head circumference
 Monitor symptoms of Cushing triad
 Document child’s gait ,behavior, changes in posture etc
 Administer pre-operative medications

19. CONT….
POST OPERATIVE
• Vital signs monitoring every 15 to 30mts until the child
is stable
• Hyperthermia may occurs due to surgical intervention in
the hypothalamus/brainstem
• Provide a cooling blanket(if needed) for the child and
monitor body temperature carefully because of risk for
hypothermia.

20. CONT….
 Perform neurological assessment including pupillary
reaction,LOC,reflexes.
 Monitor surgical dressing for evidence of drainage if it
is present apply sterile dry gauze.
 Monitor and record the amount of drainage(drain placed
in the operative site)
Positioning
• Correct positioning after surgery is critical to prevent
pressure against operative site, ICP and aspiration

21. CONT….
Positioning…………
 If a large tumor is removed the child is not placed on the
operative side because the brain may suddenly shift to
that cavity leads to damages to blood vessels, linings
and the brain itself
Infratentorial procedure:
• Positioned on either side with the bed flat
• Keep the child NPO for 24 hrs if the gag and
swallowing reflex are depressed or the child is comatose

22. CONT….
Positioning…………
Supratentorial procedure:
• head of bed is elevated 20 to 30 degrees with the child
either side or on the back
• Cranial neuropathy is less likely occurs so clear fluids
can be given soon after the child is alert, sometimes
within 24hrs.

23. CONT….
Provide extra pillows for comfort
Maintain hydration by IV fluid until oral fluids are well
tolerated
Implement interventions for reducing headache
Clam and quite environment
Restrict visitors
Prevent sudden occurrence of jarring movements
Administer analgesics – acetaminophen, codeine
Cold application

24. CONT….
 Prevent constipation
 Provide emotional support to parents
 Encourage the parents to verbalize their feelings

25. THANK YOU

26. MAKE NOTES ON
 Pre and post operative Nursing management of child
With brain tumor including nursing diagnosis