INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #94 The Neuropsychological Profile of a Pediatric Patient with Disseminated Pilocytic Astrocytoma Joanna Peters, Levine Children's Hospital, Atrium Health, Charlotte, United States Analise Ney, The University of North Carolina at Chapel Hill, Chapel Hill, United States Sofia Ladley, Tulane University, New Orleans, United States Category: Cancer Keyword 1: brain tumor Keyword 2: pediatric neuropsychology Objective: Pilocytic astrocytoma is the most common benign brain tumor in pediatrics. However, dissemination is rare. Existing literature on disseminated pilocytic astrocytoma consists largely of medical case studies, but neuropsychological outcomes have never been reported. This case study presents serial neuropsychological data of a patient with disseminated pilocytic astrocytoma across three time points. Participants and Methods: Here we describe a left-handed, White female diagnosed at age 5 years with disseminated pilocytic astrocytoma, with a primary third ventricular mass and leptomeningeal spread with lesions in the bilateral thalami, right hypothalamus/optic chiasm, left temporal lobe, right internal auditory canal, and left cerebellar tonsil. She had multiple disease progressions despite several chemotherapy regimens and surgery. The child was evaluated at age 7 years following chemotherapy, subtotal resection, and subdural then ventriculoperitoneal shunt placement and prior to aggressive resection of the third ventricular mass (T1), at age 8 following resection via bifrontal craniotomy (T2), and at age 10 following additional chemotherapy, gross total resection of a cerebellar lesion, and prior to craniospinal irradiation (T3). Comprehensive neuropsychological batteries were administered by the primary author except intelligence testing completed by the school immediately prior to the second evaluation. Results: At T1, the child presented with a predominately intact profile with high average intelligence (WISC-5 FSIQ=116). Intelligence declined over time (T3 FSIQ=103) largely reflecting significant declines in processing speed and visual working memory at T2 that remained stable at T3. Attention weaknesses were evident at T1 and persisted over time but with benefit from medication. Executive dysfunction emerged primarily in working memory and cognitive flexibility at T1 and varied over time. Memory was average at T1 (ChAMP Total Memory=99, Verbal=95, Visual=103) and declined at T2, with verbal memory more impacted (Total=82, Verbal=73, Visual=96). Memory declined further at T3 with less verbal-visual discrepancy (Total=74, Verbal=73, Visual=82). Fine motor dexterity and visual motor integration declined over time. She developed marked anxiety at T2 that resolved by T3, whereas social withdrawal that developed at T2 persisted. Conclusions: The child initially presented with a generally intact profile with limitations only in attention and executive functions. At T2, she demonstrated significant decline in memory and processing speed following resection of her primary third ventricular mass, the former likely due to disruption to Papez circuit given lesion location. Following additional chemotherapy and cerebellar lesion resection, her cognitive profile was largely stable at T3, except for 1) further decline in memory and increased executive dysfunction, likely reflecting lack of age-expected gains and 2) further fine motor impact presumably due to cerebellar involvement. Disseminated disease may implicate many brain regions and likely affects diffuse functional neural networks, such that impact on attention and executive functions may reflect a common finding across these individuals. While a rare condition, further research at the group level is severely needed. This case additionally highlights that aggressive neurosurgical intervention, whenever medically possible, should be planned in a manner that will spare as much cognitive function, and therefore quality of life, as possible.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #94

The Neuropsychological Profile of a Pediatric Patient with Disseminated Pilocytic Astrocytoma

Joanna Peters, Levine Children's Hospital, Atrium Health, Charlotte, United States
Analise Ney, The University of North Carolina at Chapel Hill, Chapel Hill, United States
Sofia Ladley, Tulane University, New Orleans, United States

Category: Cancer

Keyword 1: brain tumor
Keyword 2: pediatric neuropsychology

Objective:

Pilocytic astrocytoma is the most common benign brain tumor in pediatrics. However, dissemination is rare. Existing literature on disseminated pilocytic astrocytoma consists largely of medical case studies, but neuropsychological outcomes have never been reported. This case study presents serial neuropsychological data of a patient with disseminated pilocytic astrocytoma across three time points.

Participants and Methods:

Here we describe a left-handed, White female diagnosed at age 5 years with disseminated pilocytic astrocytoma, with a primary third ventricular mass and leptomeningeal spread with lesions in the bilateral thalami, right hypothalamus/optic chiasm, left temporal lobe, right internal auditory canal, and left cerebellar tonsil. She had multiple disease progressions despite several chemotherapy regimens and surgery. The child was evaluated at age 7 years following chemotherapy, subtotal resection, and subdural then ventriculoperitoneal shunt placement and prior to aggressive resection of the third ventricular mass (T1), at age 8 following resection via bifrontal craniotomy (T2), and at age 10 following additional chemotherapy, gross total resection of a cerebellar lesion, and prior to craniospinal irradiation (T3). Comprehensive neuropsychological batteries were administered by the primary author except intelligence testing completed by the school immediately prior to the second evaluation.

Results:

At T1, the child presented with a predominately intact profile with high average intelligence (WISC-5 FSIQ=116). Intelligence declined over time (T3 FSIQ=103) largely reflecting significant declines in processing speed and visual working memory at T2 that remained stable at T3. Attention weaknesses were evident at T1 and persisted over time but with benefit from medication. Executive dysfunction emerged primarily in working memory and cognitive flexibility at T1 and varied over time. Memory was average at T1 (ChAMP Total Memory=99, Verbal=95, Visual=103) and declined at T2, with verbal memory more impacted (Total=82, Verbal=73, Visual=96). Memory declined further at T3 with less verbal-visual discrepancy (Total=74, Verbal=73, Visual=82). Fine motor dexterity and visual motor integration declined over time. She developed marked anxiety at T2 that resolved by T3, whereas social withdrawal that developed at T2 persisted.

Conclusions:

The child initially presented with a generally intact profile with limitations only in attention and executive functions. At T2, she demonstrated significant decline in memory and processing speed following resection of her primary third ventricular mass, the former likely due to disruption to Papez circuit given lesion location. Following additional chemotherapy and cerebellar lesion resection, her cognitive profile was largely stable at T3, except for 1) further decline in memory and increased executive dysfunction, likely reflecting lack of age-expected gains and 2) further fine motor impact presumably due to cerebellar involvement. Disseminated disease may implicate many brain regions and likely affects diffuse functional neural networks, such that impact on attention and executive functions may reflect a common finding across these individuals. While a rare condition, further research at the group level is severely needed. This case additionally highlights that aggressive neurosurgical intervention, whenever medically possible, should be planned in a manner that will spare as much cognitive function, and therefore quality of life, as possible.