Posterior fossa tumors in children: how long does it take to establish the diagnosis?

Abstract

The aim of this study is to evaluate, for our patient population, the time interval from the first chart-documented symptom to the radiological diagnosis in children and infants with posterior fossa tumors. We retrospectively analyzed 50 consecutive children (36 men, 14 women) with posterior fossa tumor treated at our department between January 1999 and December 2003. The mean age at time of diagnosis was 98 months (6 months-16 years). The mean follow up was 27 months (6-61 months). The diagnoses included astrocytoma (n = 17), medulloblastoma (n = 15), ependymoma (n = 6), and other tumors (n = 12). The mean time interval between onset of symptoms and radiographic diagnosis was 142 days (5-535 days), the median was 59 days. The mean time for Grade I and II tumors was 238 days (n = 19) and for tumors Grade III and IV 117 days (n = 31). The most common presenting symptoms were headache, nausea, vomiting, ataxia, and oculomotor deficits. Approximately half of the patients were initially diagnosed and treated for other diseases (gastrointestinal infection, appendicitis, psychological behavioral problems, cervical spine strains, different ophthalmologic entities). Specialists (ophthalmologists, orthopedics) tended to diagnose and treat their specific diagnoses (e.g., strabism, torticollis). Parents play a significant role in the process of establishing the correct diagnosis. We conclude that further information and education regarding symptomatology and diagnosis of posterior fossa tumors in children is necessary. Communication has to be improved between parents and referring physicians of all specialties and neurosurgeons.