Four Health Tips to Enhancing Your Brain

By Leon Edward

Long thought to be the soul of the human psyche, the human brain weighs in at about 3 pounds or 1300-1400g. What we know about the brain expands almost daily as new science finds more and more nuances that control our perception of life around us. We know that it controls what keeps us alive: respiration, digestion, heartbeat and a number of other involuntary or automatic functions of the body. Without our brain constantly working in the background, we would not be able to live.

It also controls what we call -Our Higher Functions- or things we are consciously doing day-to-day - abstract thinking, reasoning, dreaming and thought. Considered superior to any other species, our brain is responsible for our culture, advancements and higher level thinking including reading, speech and extrapolation. Things like creativity and personality are associated with the brain. We make decisions, define colors and smells and that is just the tip of the iceberg. This very special organ perceives the world around us and our activity in it.

The human brain is strong and some may consider it invincible; however, many times as we age, we realize isn not going to stay that way forever. Like any other part of our body, the brain is subject to the ravages of time, and our lifestyles affect it to a greater or lesser degree. As we age, the brain becomes slower in its functioning and its ability to rejuvenate itself. But, through science, we have also discovered that this doesn not have to be the end of things. There are many ways to enhance and improve our brain power and forestall the slowing down that comes with aging. This article gives you four excellent tips to get your started in reversing the damages that time causes.

Tip #1: Healthy lifestyles are the key

Integral to our overall anatomy, the brain is probably the most important organ in our bodies because without it, we could not function. So, we need to treat it like the special organ that it is. For the person who drinks heavily, they are damaging their brain more than the person who is a modest drinker. We have long known that alcohol and other substances like drug use destroy brain cells. Most alcoholics will argue that since we only use 10% of our overall brainpower, we have plenty of spare brain cells to call on. This is more myth than reality. Drinking does nothing to activate the other 90% of our brain's capacity, and this fallacy will cause alcoholism to destroy our organ faster than believed. As a result, if you think of that 10% we're using as a lifetime organ, we should go to great lengths to preserve and protect it.

Tip #2: Eat well and your brain will thank you.

You know the saying: Garbage in; Garbage Out. This applies to healthy eating to keep the brain operating at peak efficiency. Consuming the correct sets of food definitely benefits the brain. Consider this: the brain is the most active part of the body. In order to keep the brain vibrant and alive, we must give it the best fuel available. The brain is always on even when we are sleeping, so having an abundance of good fuel will keep the brain fit and thriving. Good foods will be greatly appreciated by your brain, and in return it will deliver excellent computing and reasoning powers. Never underestimate the power of a balanced diet, exercise and adequate sleep when it comes to staying focused and alert.

Tip #3: Exercise Makes the Brain Grow Stronger

Taking the time to get proper exercise is an excellent way for the body and brain to operate at maximum effectiveness. Leading a well-balanced lifestyle goes a long way towards having a brain that is alive, fit and ready to tackle any problem that the world throws at it.

Tip #4: Relieving Stress is Essential

Exercise also releases stress which can cloud and slow the brains functioning and create a good mood and a sense of well being.

The brain is an organ that should be respected, cared for and cherished. We only have one, and it allows us to make choices, and live our lives to the fullest. A well-cared for brain will deliver healthy perceptions, and result in a more active and fulfilled existence.

Classification of Brain Tumor

By Peter Sams

A brain tumor — primary or secondary — can cause a variety of signs and symptoms because it can directly press on or invade brain tissue. This can damage or destroy areas responsible for sight, movement, balance, speech, hearing, memory or behavior. Brain tumor symptoms vary from patient to patient, and most of these symptoms can also be found in people who do NOT have brain tumors.

Therefore, the only sure way to tell if you have a brain tumor or not is to see your doctor and get a brain scan. The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (non-cancerous) or malignant. A primary brain tumor is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumors in adults. Brain tumors encompass neoplasms that originate in the brain itself (primary brain tumors) or involve the brain as a metastatic site. Brain tumors (metastatic brain tumors), which are malignant, are more common. These tumors result from cancer that started elsewhere in the body and spread (metastasized) to the brain.

Classification

HISTOPATHOLOGIC CLASSIFICATION — Primary brain tumors are classified by light microscopy according to their predominant cell type and graded based upon the presence or absence of standard pathologic features. Historical attempts at developing a classification system for brain tumors date back to the 1830s. The German pathologist Rudolf Virchow first introduced the term "glioma" in 1860. Virchow was also the first to attempt a correlation of microscopic to macroscopic features of CNS tumors.

Cellular Classification-He classification of brain tumors is based on both histopathological characteristics and location in the brain. Undifferentiated neuroectodermal tumors of the cerebellum have historically been referred to as medulloblastomas, while tumors of identical histology in the pineal region would be diagnosed as pineoblastomas. The nomenclature of pediatric brain tumors is controversial and potentially confusing. Some pathologists advocate abandoning the traditional morphologically-based classifications such as medulloblastoma in favor of a terminology that relies more extensively on the phenotypic characteristics of the tumor.

Primary Brain Tumor

Astrocytomas — these tumors arise from small, star-shaped cells called astrocytes. They may grow anywhere in the brain or spinal cord. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum and the cerebellum. A grade III astrocytoma is sometimes called anaplastic astrocytoma. A grade IV astrocytoma is usually called glioblastoma multiforme.

Brain stem gliomas — These tumors occur in the lowest, stem-like part of the brain. The brain stem controls many vital functions. Most brain stem gliomas are high-grade astrocytomas.

Secondary Brain Tumor

Metastatic brain tumors originate from malignant tumors located primarily in other organs. Their incidence is higher than that of primary brain tumors. The most frequent types of metastatic brain tumors originate in the lung skin (malignant melanoma, kidney (hypernephroma, breast (breast carcinoma), and colon (colon carcinoma). These tumor cells reach the brain via the blood-stream.
Some non-tumoral masses and lesions can mimic tumors of the central nervous system. These include tuberculosis of the brain, cerebral abscess (commonly in toxoplasmosis), and hamartomas

Different Types of Brain Injury

By Dave J. Davies

Brain injury can be as individual as people, because every case of brain injury can happen for different reasons and have different effects on people. Classifying the different types of brain injury can require a lot of research. Generally the classification starts with the two more common types of brain injury: traumatic brain injury and acquired brain injury. The levels are ranted as mild, moderate or severe. Brain injuries can also be classified as an open or closed brain injury. In this article, we'll talk about the more common types of brain injuries.

Traumatic Brain Injury

Traumatic brain injury can happen whenever something strikes the head with force. The force would be strong enough to cause the brain to move in the skull causing internal damage to the brain. It can also occur if the skull breaks and the break itself injures the brain.

There are various reasons for this type of force. It could due to a violent experience, sports injury or a variety of other causes. Any event that causes the head to be struck hard enough an cause this type of traumatic brain injury.

This type of brain injury can also occur from rapid movement back and forth, shaking the brain hard enough in the skull that it becomes damaged. This more commonly happens in auto accidents or in cases such as Shaken Baby Syndrome. The rapid movement back and forth can do severe damage to the brain.

How To Tell If You've Suffered Traumatic Brain Injury

If you have suffered a severe blow to the head, or have been in an accident where your head was violently shaken, or suspect someone else has had this type of injury, go to the emergency room immediately or call 911 for further assistance. It is recommended that you do not wait. Severe brain injuries can become worse and could become fatal if not treated immediately.

Common symptoms of traumatic brain injury are as follows:

Spinal fluid coming out of the ears or nose, looking like thin, watery liquid
Loss of consciousness
Suspected concussion - not all concussions cause loss of consciousness
Severe dizziness or loss of balance
Dilated eyes
Loss of vision, or change in vision, either improved or reduced
Slow pulse
Slow breathing
Vomiting
Lethargic
Headache
Confusion
Numbness or tingling sensations in any parts of the body

Different Types of Traumatic Brain Injury

Depending on how severe the injury is, the brain can suffer many types of injuries. Some of the more common classifications of such injuries include:

Diffuse Axonal Injury - This type of injury seems to be more common with the rapid movement of the head as occurs with Shaken Baby Syndrome. It usually happens because the skull is moving faster than the brain, causing certain structures in the brain to tear. This injury can be temporary or permanent, causing a coma or even possibly producing fatal effects.

Concussion - A concussion can be caused by violent action toward the head, by severe blows, or a whiplash effect. This type of injury causes blood vessels to stretch. It's one of the more common types of brain injuries, and a concussion can take months or even years to fully heal.

Contusion - Again, this type of traumatic brain injury will happen with a violent action at the head. The injury is caused by bruising or bleeding on the brain. If the injury is severe and there is much bruising and bleeding, it can require surgery to correct.

Acquired Brain Injury

An acquired brain injury occurs any time after birth and is not induced by birth trauma or hereditary. This type of injury occurs on a cellular level. Such an injury can affect the entire brain, rather than a limited area like a traumatic brain injury.

Such injuries can occur for any of the following reasons: air obstruction, chocking, throat swelling, near drowning, electrical shock, trauma to the head, severe blood loss from open wounds, heart attack, stroke, infectious diseases, Meningitis, AIDS, brain tumors, toxic exposure, illegal drug use, overdose of drugs, alcohol abuse.

Symptoms of Acquired Brain Injury

Because this type of brain injury is internal, you might have a harder time trying to identify the symptoms. Some of the more common symptoms for acquired brain injury are:

Impairment of function, motor skills or memory
Long lengths of time spent in a still, 'vegetative' state
Sudden or severe behavior changes or problems - depression, restlessness, anxiety, psychosis, etc

As with traumatic brain injury, if you suspect someone may have acquired brain injury, call 911 or get the person to the emergency room right away.

Different Types of Acquired Brain Injury

Anoxic Brain Injury - This type of injury occurs when the brain is deprived of oxygen. There are three types of anoxia: Anoxic which is no oxygen is getting through, anemic which means severely limited amounts of oxygen is getting through, and toxic which means something is blocking the oxygen in the blood from being used in the brain.

Hypoxic Brain Injury - This sort of brain injury occurs when the brain does get oxygen, but doesn't seem to get enough oxygen. It could happen because of lack of blood flow or blood pressure is weak.

If you should suffer from any symptoms listed, have suffered a blow to the head or you suspect that you or someone you know may have any form of brain injury, seek medical treatment right away. Call 911 if you see someone who has had an injury to the head, even if that person says they are fine. When caught early enough, many types of brain injuries are treatable.

The needs of medical assistant during brain surgery

I‘ve attended several brain surgeries in my previous employment. During that, I learned a lot. Usually there will be one senior neurosurgeon who’s in charge of the surgery, then he’ll be accompanied by junior neurosurgeon as his assistant. Then comes several medical assistants. They are there to support the surgeons and make sure everything comes to place. In the sterile area there will be around 4 people, including senior and junior neurosurgeons.

Some medical assistant will take care of anesthesia, some will take care of big equipments, some handles and cleans the surgical instruments. It’s complicated and need special skills.

I asked them how they got the skill. They said, after finished medical assistant schools and got hired, there are specialization, which surgery field that they will work on. Then the hospital will send them for training and attend workshops.

In medium size hospitals in remote area in Indonesia, usually there is only one neurosurgeon, there is no other surgeon to help him. The medical assistants play important role. They prepare the patient before surgery, and they stitch the wounds after neurosurgeon finishes his part. The neurosurgeon relies on them.

More information on Hydrocephalus

Reference: "Hydrocephalus" by Eugenia-Daniela Hord, MD, Instructor, Departments of Anesthesia and Neurology, Massachusetts General Hospital Pain Center, Harvard Medical School

Pathophysiology

Normal CSF production is 0.20-0.35 mL/min; a majority is produced by the choroid plexus, which is located within the ventricular system, mainly the lateral and fourth ventricles. The capacity of the lateral and third ventricles in a healthy person is 20 mL. Total volume of CSF in an adult is 120 mL.

Normal route of CSF from production to clearance is the following: From the choroid plexus, the CSF flows to the lateral ventricle, then to the interventricular foramen of Monro, the third ventricle, the cerebral aqueduct of Sylvius, the fourth ventricle, the 2 lateral foramina of Luschka and 1 medial foramen of Magendie, the subarachnoid space, the arachnoid granulations, the dural sinus, and finally into the venous drainage.

ICP rises if production of CSF exceeds absorption. This occurs if CSF is overproduced, resistance to CSF flow is increased, or venous sinus pressure is increased. CSF production falls as ICP rises. Compensation may occur through transventricular absorption of CSF and also by absorption along nerve root sleeves. Temporal and frontal horns dilate first, often asymmetrically. This may result in elevation of the corpus callosum, stretching or perforation of the septum pellucidum, thinning of the cerebral mantle, or enlargement of the third ventricle downward into the pituitary fossa (which may cause pituitary dysfunction).

The mechanism of NPH has not been elucidated completely. Current theories include increased resistance to flow of CSF within the ventricular system or subarachnoid villi; intermittently elevated CSF pressure, usually at night; and ventricular enlargement caused by an initial rise in CSF pressure; the enlargement is maintained despite normal pressure because of the Laplace law. Although pressure is normal, the enlarged ventricular area reflects increased force on the ventricular wall.

Frequency

United States

Incidence of congenital hydrocephalus is 3 per 1,000 live births, while the incidence of acquired hydrocephalus is not known exactly.

International

Incidence of acquired hydrocephalus is unknown. About 100,000 shunts are implanted each year in the developed countries, but little information is available for other countries.

Mortality/Morbidity

In untreated hydrocephalus, death may occur by tonsillar herniation secondary to raised ICP with compression of the brain stem and subsequent respiratory arrest.

• Shunt dependence occurs in 75% of all cases of treated hydrocephalus and in 50% of children with communicating hydrocephalus.
• Patients are hospitalized for scheduled shunt revisions or for treatment of shunt complications or shunt failure.
• Poor development of cognitive function in infants and children, or loss of cognitive function in adults, can complicate untreated hydrocephalus. It may persist after treatment.
• Visual loss can complicate untreated hydrocephalus and may persist after treatment.

Sex

Generally, incidence is equal in males and females. The exception is Bickers-Adams syndrome, an X-linked hydrocephalus transmitted by females and manifested in males. NPH has a slight male preponderance.

Age

Incidence of human hydrocephalus presents a bimodal age curve. One peak occurs in infancy and is related to the various forms of congenital malformations. Another peak occurs in adulthood, mostly resulting from NPH. Adult hydrocephalus represents approximately 40% of total cases of hydrocephalus.

More on Hydrocephalus

Common Causes of Hydrocephalus

Although rare, hydrocephalus can be inherited genetically or may be associated with developmental disorders, including spina bifida (congenital defect of the spine) and encephalocele (hernia of the brain). Other causes can include bleeding within the brain, brain tumors, head injuries, complications of premature birth such as hemorrhage, or diseases such as meningitis or other infections. In some cases, normal flow of CSF within the brain is blocked, resulting in fluid build-up.

Symptoms of hydrocephalus vary greatly from person to person. According to the Hydrocephalus Association, some of the most common symptoms are listed below as a reference.

Symptoms of Hydrocephalus in infants Abnormal enlargement of the head; soft spot (fontanel) is tense and bulging; scalp can appear thin; bones separated in baby's head; prominent scalp veins; vomiting; drowsiness; irritability; downward deviation of baby's eyes; seizures; or poor appetite.

Symptoms of Hydrocephalus in toddlers/children
Abnormal enlargement of baby's head; headache; nausea; vomiting; fever; blurred or double vision; unstable balance; irritability; sleepiness; delayed progress in walking or talking; poor coordination; change in personality; inability to concentrate; loss of sensory motor functions; seizures; or poor appetite. Older children may experience difficulty in remaining awake or waking up.

Symptoms of Hydrocephalus in young and middle-aged adults
Headache; difficulty in remaining awake or waking up; loss of coordination or balance; bladder control problems; impaired vision and cognitive skills that may affect job performance and personal skills.

Symptoms of Hydrocephalus in older adults
Loss of coordination or balance; shuffling gait, memory loss; headache; or bladder control problems. Hydrocephalus is often categorized for age groups as either congenital or normal pressure hydrocephalus. Congenital hydrocephalus refers to conditions that are caused by conditions existing at birth. Primary symptoms include headache, nausea, vomiting and drowsiness. Normal pressure hydrocephalus (NPH) is the accumulation of cerebrospinal fluid that causes the ventricles in the brain to become enlarged, with little or no increase in pressure. Adult-onset NPH mainly occurs in adults age 60 and older. Patients with NPH often get misdiagnosed with Alzheimer's disease or dementia, as some of the symptoms mimic these two conditions.

Diagnosing Hydrocephalus

Before your doctor can recommend a course of treatment, he or she will:

• Review your medical history, and perform a physical examination
• Perform a complete neurological examination including diagnostic testing if needed
• Ask specific questions to determine if symptoms are caused by hydrocephalus

The neurological examination will also help to determine the severity of your condition. Further tests such as an ultrasound (if the patient is an infant), computed tomography (CT or CAT scan), or magnetic resonance imaging (MRI) may be ordered. The tests may reveal useful information about the severity of the condition and its likely cause.

When Surgery is Necessary

Hydrocephalus can be treated in a variety of ways. The problem area may be treated directly (by removing the cause of CSF obstruction), or indirectly (by diverting the fluid to somewhere else; typically to another body cavity). Indirect treatment is performed by implanting a device known as a shunt to divert the excess CSF away from the brain. The body cavity in which the CSF is diverted is usually the peritoneal cavity (the area surrounding the abdominal organs).

In some cases, two procedures are performed, one to divert the CSF, and another at a later stage to remove the cause of obstruction (e.g., a brain tumor). Once inserted, the shunt system usually remains in place for the duration of a patient's life (although additional operations to revise the shunt system are sometimes needed). The shunt system continuously performs its function of diverting the CSF away from the brain, thereby keeping the intracranial pressure within normal limits.

An alternative operation called endoscopic third ventriculostomy utilizes a tiny camera to look inside the ventricles, allowing the surgeon to create a new pathway through which CSF can flow.

Recovery

Your neurological function will be evaluated post surgery. If any neurological problems persist, rehabilitation may be required to further your improvement. However, recovery may be limited by the extent of the damage already caused by the hydrocephalus and by your brain's ability to heal.

Because hydrocephalus is an ongoing condition, long-term follow-up by a doctor is required. Follow-up diagnostic tests including CT scans, MRIs and x-rays, are helpful in determining if the shunt is working properly. Do not hesitate to contact your physician if you experience any of the following postoperative symptoms:

• Redness, tenderness, pain or swelling of the skin along the length of the tube or incision
• Irritability or drowsiness
• Nausea, vomiting, headache or double vision
• Fever
• Abdominal pain
• Return of preoperative neurological symptoms

Prognosis

The prognosis for hydrocephalus depends on the cause, the extent of symptoms, and the timeliness of diagnosis and treatment. Some patients show a dramatic improvement with treatment while others do not. In some instances of NPH, dementia can be reversed by shunt placement. Other symptoms such as headaches may disappear almost immediately if the symptoms are related to elevated pressure.

In general, the earlier hydrocephalus is diagnosed, the better the chance for successful treatment. The longer the symptoms have been present, the less likely it is that treatment will be successful. Unfortunately, there is no way to accurately predict how successful surgery will be for each individual. Some patients will improve dramatically while others will reach a plateau or decline after a few months.

Shunt malfunction or failure may occur. The valve can become clogged or the pressure in the shunt may not match the needs of the patient, requiring additional surgery. In the event of an infection, antibiotic therapy may be needed. A shunt malfunction may be indicated by headaches, vision problems, irritability, fatigue, personality change, loss of coordination, difficulty in waking up or staying awake, a return of walking difficulties, mild dementia or incontinence. Fortunately, most complications can be dealt with successfully.

Source: NeurosurgeryToday.Org

WHAT CAN I DO TO IMPROVE MY MEMORY?

Source: Traumatic Brain Injuries

Work with a Specialist in Memory--One of the most important things is to get help from people who specialize in head injury. Every head injury program has a specialist who teaches memory strategies. In most cases, this is a Speech Therapist (they don't just help people who have slurred speech). In the Neuro-Recovery program, our Speech Therapist teaches 15 different memory strategies and helps you to pick the 2 or 3 that work best for you. There is often a fair amount of testing in order to figure out the best memory strategy for each head-injured person. For some people, one type of memory may be impaired (verbal recall) but another type be intact (remembering visual information). If I know that my verbal memory is not very good, I write things down and encourage visual memory systems to work. Specialists can help you pick out the best memory strategies to help you. Once you find an effective strategy, keep working on it. Think of memory like a muscle. The more you use it, the stronger it gets.

Get Organized--We learn better if we are organized. Many people have told me that, prior to their head injury, they had incredibly messy desks with papers all over. But if someone came in and said, "I need this particular paper", they could pull it out of a big pile and say "here it is." After a head injury, though, the ability to organize gets really messed up. One symptom of not being organized is when someone says, "I've started 50 projects and haven't finished one of them." If you organize information, it tends to help you recall it. For example, if you are constantly losing your car keys or constantly forgetting where you put your wallet, there's one simple technique to use. Put things in the same place. Always put your car keys in one spot on the dresser. Always put your purse in one spot in the house and nowhere else. Being organized helps your memory and you will be less likely to lose things.

Break It Down--Another thing that we can do to help memory is to break it into small bits. If you have something really tough to learn, try to break it down into small bits and then learn each one little bit at a time. Some people call this "chunking;" you are memorizing little "chunks" of information. For example, your brand new VCR has a remote control with 50 buttons on it. Reading the entire manual in one sitting to learn what all of the 50 buttons do is very hard. So, learn one function and then play with that feature for awhile. Once you've learned that, go on to the next button. We've been using this technique for years to learn simple information like a phone number. The wonderful folks at Bell Labs (they invented the phone) figured out that people will learn a 7 digit phone number if you group 3 digits together and then group 4 digits together (a "chunk" of 3 numbers and a "chunk" of 4 numbers).

Using Association-- Association is really important for retrieving important information. For example, you are taking a literature course and you need to remember a famous essayist--Francis Bacon. You might associate the image of a piece of bacon with the name of this person. So if you're trying to think of this explorer, an image of a piece of bacon will come to you. This approach is particularly helpful with learning names. Remembering names is a difficult task for most people in the world; it is especially hard for most people with a head injury.

Get a Daily Planner--Probably one of the best things you can do to help your memory is to use a daily planner. This brings up two important points:

• The First Rule of Memory--write everything down in one spot (your daily planner).

• The Second Rule of Memory--write it down when it's fresh in your mind.

For example, you go to your doctor's office and you are asked to return for another appointment. Many people have a calendar stuck on their refrigerator or on a wall at home. By the time you get back home, you've forgotten the date or lost the appointment card. Next time, bring a planner to the doctor's office and write your appointment in it just after the doctor tells you the date. Get a medium size planner or something called an organizer. Don't get something that's too small--you're going to be doing a lot of writing. Write complete notes! Some people make notes so short that they later can't figure out what the note means.

Make A "To Do" List--In addition to a planner, make a "to do" list. For example, you may have a number of chores to do around the house but none of them in any particular order. What you can do is get a small pad of paper and write down the things that they have to do. Once you have this list, decide which task to do first, second, third, and so on. This will work if your list doesn't get too long. If the list gets too long, you're going to run into problems.

Make a "Modified To Do" List--I commonly hear the same problem, "I've got 50 projects going but I haven't finished any of them." This is a combined problem of memory deficits and organizational deficits. One solution is to buy a small dry-erase board and put it up in the home (or office). On the board, you are only allowed to list five items on the "To Do" list. You cannot add another item to the board until you have completed one of the items already on the board. Make a "Modified To Do List" and put it somewhere in your house where the whole family can see it. Family can also offer suggestions to help you to get projects organized. This will in turn help family members get a better understanding of what the head-injured person has to deal with. When you get organized and use the Planner/To Do List, you'll feel better about yourself because you will be getting things accomplished.

The effects of hydrocephalus on intelligence quotient in children with localized infratentorial ependymoma before and after focal radiation therapy

By: THOMAS E. MERCHANT, D.O., PH.D., HEATHER LEE, M.D., JUNHONG ZHU, M.S.,
XIAOPING XIONG, PH.D., GREGORY WHEELER, M.B.B.S., SEAN PHIPPS, PH.D.,
FREDERICK A. BOOP, M.D., AND ROBERT A. SANFORD, M.D.

Departments of Radiation Oncology and Biostatistics, St. Jude Children’s Research Hospital,
Memphis, Tennessee


Object. The goal of this study was to determine the influence of hydrocephalus on intelligence quotient (IQ) in children with infratentorial ependymoma before and after the administration of focal radiation.

Methods. Measurements of ventricular size, including Evans index (EI), cella media index (CMI), frontal horn diameter (FHD), and ventricular angle, were performed using magnetic resonance imaging at the time of diagnosis and again at 3, 6, 9, and 12 months after the initiation of radiation therapy. Of the 59 patients (median age at time of radiation treatment, 4.1 years), the clinical diagnosis established in 50 (85%) was hydrocephalus and 23 (39%) required placement of a cerebrospinal fluid (CSF) shunt. Extent of resection was gross or near total in 50 (85%). Before and after radiation treatment, IQ was measured using age-appropriate testing. The correlation between multiple ventricular measurements and IQ was investigated using standard regression techniques and a generalized linear model.
Patients with a higher EI (p = 0.04), CMI (p = 0.001), and FHD (p = 0.0002) at the time of diagnosis were more likely to have lower IQ scores before radiation treatment. Patients with higher CMI (p = 0.04) and FHD (p = 0.01) at the time of diagnosis were more likely to exhibit an increase in IQ score after radiotherapy. The rate of change in IQ after radiation treatment was positively correlated with the CMI intercept (p = 0.015) and negatively correlated with the rate
of FHD change (p = 0.006).

Conclusions. Changes in IQ score before and after radiation treatment are significantly influenced by the extent and treatment of hydrocephalus at the time of diagnosis. Hydrocephalus is an important factor to include when analyzing the effects of treatment. Patients who undergo a second surgery for ependymoma are more likely to require the placement of a CSF shunt (p = 0.0001).


KEY WORDS • ependymoma • hydrocephalus • cognition • radiation treatment • pediatric neurosurgery

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