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Long-term sequelae in children after cerebellar astrocytoma surgery

From the Department of Child Neurology (F.K. Aarsen, and Drs. Van Dongen and Catsman-Berrevoets), Department of Pediatric Oncology and Hematology (F.K. Aarsen), Erasmus MC/Sophia Children’s Hospital, Rotterdam, The Netherlands; Department of Neurology (Dr. Paquier), University Hospital Erasme (ULB), Brussels; Department of ENT Surgery (Dr. Paquier), University of Antwerp (UA), School of Medicine; Department of Linguistics (Dr. Paquier), Free University of Brussels (VUB/ULB), Belgium; and Department of Medical Psychology (Dr. van Mourik), Hospital Walcheren, Vlissingen, The Netherlands.

Address correspondence and reprint requests to F.K. Aarsen, Pediatric Neuropsychologist, Department of Pediatric Neurology, Erasmus MC/Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; e-mail: f.aarsen{at}erasmusmc.nl

Objective: To study long-term effects on neurologic, neuropsychological, and behavioral functioning in children treated for cerebellar pilocytic astrocytoma (CPA) without additional radio- and chemotherapy.

Methods: The authors assessed speech, language, nonverbal intelligence, attention, memory, executive skills, and visual (-spatial) functions in a consecutive series of 23 children. Neurologic and neuropsychological follow-up ranged from 1 year to 8 years and 10 months after resection.

Results: Long-term sequelae in the investigated domains were found in all children. Apraxia, motor neglect, and dysarthric features, as well as language, sustained attention, visual-spatial, executive, memory, and behavioral problems, were observed in various combinations and to different degrees. No clear pattern of neurocognitive disturbances could be discerned in this group. In addition, significant relationships were revealed between severity of preoperative hydrocephalus and visual-spatial skills. The high percentage of children who needed special education reflects the severity of the impairments.

Conclusion: Despite the current opinion of a good quality of life after CPA treatment, careful long-term neurocognitive follow-up is needed in order to inform parents and teachers about the behavioral and cognitive sequelae and to contribute to timely social and educational intervention.

Received March 24, 2003. Accepted in final form December 23, 2003.

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