Spectrum of pediatric posterior fossa tumors at three selected hospitals in Uganda

Abstract

Pediatric primary brain tumors are the second most common types of childhood cancers, following hematologic malignancies. They constitute the most prevalent solid tumors in cPediatric primary brain tumors are the second most common types of childhood cancers, following hematologic malignancies. They constitute the most prevalent solid tumors in children, making up approximately 40–50% of all pediatric tumors. To date, there is limited published institutional or multi-institutional data regarding the profile of pediatric posterior cranial fossa brain tumors, in Sub-Saharan Africa, especially in Uganda. this study aimed to describe the clinical presentation and cranial computer tomography scan findings in children with posterior cranial fossa at three selected hospitals in Uganda. This retrospective cross-sectional hospital-based study analyzed pediatric patients' records and cranial CT images from the past 7 years (2015 – 2022) at three selected hospitals. It focused on patients aged 0 to 18 years with a histological diagnosis. Data was collected, entered into Redcap through double entry, cleaned, and analyzed using STATA 15.1. Age was presented as mean ± standard deviation or median (interquartile range), while sex and types of posterior cranial fossa tumors were presented as proportions. The study included patients with a median age of 7 years [IQR: 4 – 11 years], with a majority being female (60.6%). The most common intracranial tumor types were Juvenile Pilocytic Astrocytoma (JPA) at 29.4%, followed by medulloblastoma at 26.5%, and Brain/pontine glioma at 25.4%. Clinical presentations included ataxia (50%) in hemicerebellar syndrome and hemiparesis (29.4%) in focal brain stem compression. Increased intracranial pressure was commonly associated with headache (55.9%) and vomiting (47.1%). The location of posterior fossa tumors (PCF) had significant associations with histological diagnosis: midline (χ2 = 66.9291, p = 0.000), other brain structures (χ2 = 30, p = 0.026), and left side (χ2 = 16, p = 0.004). Significant differences (χ2 = 38.71, p = 0.000) were found among histological tumor types and density-heterogeneity-contrast, as well as contrast enhancement patterns (χ2 = 27.48, p = 0.000) and hydrocephalus (χ2 = 23, p = 0.000) with histological tumor diagnoses. However, there was no significant association (χ2 = 6.5704, p = 0.160) among different histological tumor types and calcifications. Furthermore, a significant statistical difference (χ2 = 14.59, p = 0.007) was observed among various diagnosed histological tumors in relation to mass effect-parenchymal edema. However, there was a statistically insignificant difference (χ2 = 10.043, p = 0.283) in the location of posterior fossa tumors in the brain among different diagnosed histological tumor types. In conclusion, the location of posterior fossa tumors (PCF) is significantly related to histological diagnosis: midline, other brain structures, and left side. Significant differences were found in tumor characteristics, including density, contrast enhancement patterns, and hydrocephalus. However, no significant association was found with calcifications. Importantly, mass effect-parenchymal edema significantly varied among histological tumor types, but the location of posterior fossa tumors did not. Therefore, clinical presentations and radiological findings can assist in profiling posterior fossa tumors in pediatric patients.hildren, making up approximately 40–50% of all pediatric tumors. To date, there is limited published institutional or multi-institutional data regarding the profile of pediatric posterior cranial fossa brain tumors, in Sub-Saharan Africa, especially in Uganda. this study aimed to describe the clinical presentation and cranial computer tomography scan findings in children with posterior cranial fossa at three selected hospitals in Uganda. This retrospective cross-sectional hospital-based study analyzed pediatric patients' records and cranial CT images from the past 7 years (2015 – 2022) at three selected hospitals. It focused on patients aged 0 to 18 years with a histological diagnosis. Data was collected, entered into Redcap through double entry, cleaned, and analyzed using STATA 15.1. Age was presented as mean ± standard deviation or median (interquartile range), while sex and types of posterior cranial fossa tumors were presented as proportions. The study included patients with a median age of 7 years [IQR: 4 – 11 years], with a majority being female (60.6%). The most common intracranial tumor types were Juvenile Pilocytic Astrocytoma (JPA) at 29.4%, followed by medulloblastoma at 26.5%, and Brain/pontine glioma at 25.4%. Clinical presentations included ataxia (50%) in hemicerebellar syndrome and hemiparesis (29.4%) in focal brain stem compression. Increased intracranial pressure was commonly associated with headache (55.9%) and vomiting (47.1%). The location of posterior fossa tumors (PCF) had significant associations with histological diagnosis: midline (χ2 = 66.9291, p = 0.000), other brain structures (χ2 = 30, p = 0.026), and left side (χ2 = 16, p = 0.004). Significant differences (χ2 = 38.71, p = 0.000) were found among histological tumor types and density-heterogeneity-contrast, as well as contrast enhancement patterns (χ2 = 27.48, p = 0.000) and hydrocephalus (χ2 = 23, p = 0.000) with histological tumor diagnoses. However, there was no significant association (χ2 = 6.5704, p = 0.160) among different histological tumor types and calcifications. Furthermore, a significant statistical difference (χ2 = 14.59, p = 0.007) was observed among various diagnosed histological tumors in relation to mass effect-parenchymal edema. However, there was a statistically insignificant difference (χ2 = 10.043, p = 0.283) in the location of posterior fossa tumors in the brain among different diagnosed histological tumor types. In conclusion, the location of posterior fossa tumors (PCF) is significantly related to histological diagnosis: midline, other brain structures, and left side. Significant differences were found in tumor characteristics, including density, contrast enhancement patterns, and hydrocephalus. However, no significant association was found with calcifications. Importantly, mass effect-parenchymal edema significantly varied among histological tumor types, but the location of posterior fossa tumors did not. Therefore, clinical presentations and radiological findings can assist in profiling posterior fossa tumors in pediatric patients.