​Central Nervous System Tumours​

Central nervous system is a part of the nervous system comprising of the brain and the spinal cord. Together the brain and spinal cord, through an intricate system, conduct activities of various parts of the body, and maintain coordination among them. Tumours are mass of cells that may grow anywhere in the body and cause harmful effects. In children, most commonly occurring tumours are those growing in the brain and spinal cord and are termed as central nervous system tumours.

Tumours are classified on the basis of type of cells that originated the tumour. Furthermore, they are classified according to their degree of aggressiveness. Tumours that develop from glial cells are called glial tumours and each type of glial tumour is further classified based on their rate of growth and other factors. Glial cells are one of the two major cells found in brain; the other type is the neuron.

Spinal cord tumours are those that develop in the spinal cord itself, while vertebral tumours develop in the vertebrae (bones of the spine). A general classification of spinal cord tumours includes:

  • Intramedullary tumours: tumours that begin in the cells within the spinal cord such as astrocytomas.

  • Extramedullary tumours: Tumours that develop within the supporting network of cells around the spinal cord. Although they do not begin within the spinal cord itself, these types of tumours may affect spinal cord function by causing spinal cord compression and other problems. Such as, meningiomas.

All of these central nervous system tumours may fall under one of the two tumour categories;

Malignant (cancerous): These tumours grow very rapidly and can also affect surrounding tissues and parts of the brain.

Benign (non-cancerous): Their growth is slow and so they do not spread or affect surrounding areas of the brain

Tumours are also described by the stage at which they are present. These stages show the extent to which they have spread in the body and affected the surrounding tissues or organs. Stage of a tumour may be determined by scanning images of the tumour and also during the surgery.

The most commonly occurring tumours of the central nervous system are as follows.

  • Astrocytoma

It grows by cells called astrocytes and is more common in children between five to eight years of age.

It may develop in different parts of the brain like cerebellum; the back part of the brain responsible for coordination and balance, cerebrum; the top part of the brain that controls motor activities and talking, diencephalon; the central part of the brain that controls vision, hormone production, and arm and leg movement, the brain stem; which controls eye and facial movement, arm and leg movement, and breathing, the spinal cord; which controls sensation and arm and leg motor function.

 Astrocytoma can be a high grade or low grade tumour.

Symptoms include clumsiness of one hand, gait changes (stumbling to one side), headache and vomiting

  • Brainstem glioma

It grows from glial cells present in the brainstem. Most tumours grow in a part of brainstem called pons.

This tumour is very aggressive and is usually diagnosed after growing to a large size.

It usually grows in children between ages of five to ten.

Signs include double vision, facial weakness, difficulty walking, and vomiting

Many risks are associated with treating this tumour; hence alternative therapies are preferred over surgical intervention.

  • Ependymoma

 It is a type of brain tumour and grows from cells present in the ventricles of brain, causing hindrance in the ​normal flow of cerebrospinal fluid.

 Symptoms include headache, vomiting, and loss of muscle control

  •  Medulloblastoma (MDL)

It grows from cells in the cerebellum; the part of brain that is responsible for coordination and balance. But it can also spread along the spinal cord.

 Symptoms may include headache, vomiting and fatigue.
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Symptoms in central nervous system tumours may vary depending upon the location, size, aggressiveness and grade of tumour and age of the child. General symptoms associated to brain tumours include:

  • Headaches that gradually become more frequent and more severe

  • Nausea or vomiting

  • Vision problems, such as blurred vision, double vision or loss of peripheral vision

  • Gradual loss of sensation or movement in limbs

  • Difficulty with balance

  • Speech problems

  • Hearing problems

  • Confusion in everyday matters

  • Personality changes

  • Seizures

General symptoms associated to spinal tumours include:

  • Back pain, sometimes radiating to other parts of your body

  • Loss of sensation, especially in your arms or legs

  • Difficulty in walking

  • Decreased sensitivity to pain, heat and cold

  • Loss of bowel or bladder function

  • Muscle weakness 

Infants show some non-verbal symptoms for brain and spinal tumours such as:

  • Sleepiness

  • Irritability

  • Problems in basic development of the infant

  • Difficulty in sitting or crawling

  • Macroencephaly (big heads) when skull bones are not completely fused​

The symptoms of central nervous system tumours are usually similar to those of other diseases. But, if you notice any of the above mentioned symptoms in your child that are persistent and if you have a family history of cancer, then consult one of our doctors from the Mind and Brain Service Line at The Aga Khan University Hospital. ​​
Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started. ​​​

After taking a medical history and physical examination of you or your child, doctor will proceed with the evaluation by ordering certain diagnostic tests such as;

  • X-ray: Gives images of skull bones and internal tissues and helps in detecting any incurred damage to the bones by the tumour

  • Magnetic resonance imaging (MRI) and Computed Tomography (CT) scan: Gives more detailed images than X-ray and helps in identifying the size, type and location of the tumour.

  • Angiogram: To detect specific types of tumours, a dye is inserted during X-ray to clearly view the blood vessels.

  • Positron Emission Tomography (PET): By measuring metabolic activity of cells; this test detects certain tumours that cannot be detected through CT Scan or MRI

  • Biopsy: To determine the nature of the tumour, biopsy is performed by taking a small sample of tissue from the tumour. This may be done during surgery or before surgery by a needle. The needle is inserted into the body depending on where the tumour is located a small tissue sample is collected and then observed under microscope. This is an important test for determining the required treatment.​​

The Aga Khan University Hospital provides multidisciplinary medical care under one roof. Doctors from the Mind and Brain Service Line at The Aga Khan University Hospital will work in collaboration with doctors from other service lines including those related to Paediatric Haematology/Oncology and neuro-oncology to deliver the best services to your child. 

  • Surgery:  Surgery is usually the first and most preferred option to remove the tumour if it is located in an accessible region of the brain and spinal cord and minimal risks of any detrimental damage to the nervous system by the surgical intervention are present. Most tumours can be entirely removed by surgery. For high grade tumours however, this is not possible and surgery is followed up by a series of therapies. 

  • Radiation Therapy: High energy beams are passed through the body on the tumour and its surrounding area to make it less aggressive. This therapy is employed in addition to surgery or, in some cases; it eliminates the need of surgery. 

  • Chemotherapy: Certain anti-cancer medications are used to treat brain tumour. Chemotherapy is carried out to achieve various goals like, to reduce the size of tumour before surgery, to eliminate any tumour cells remaining after surgery etc. 

  • Rehabilitation: After treatment, your child may need certain rehabilitation assistance which shall be provided by physiatrist, occupational therapist, speech language pathologist, developmental therapist, mental health specialist and special education teacher.​​

Please click here ​for some guidelines on what to do before your surgery.​​
Please click he​re for some guidelines on what to do on the day of your surgery.​​

Chemotherapy may result in nausea, vomiting and hair loss. Following complications may occur due to surgery;

  • Bleeding

  • Infection

  • If tumour is close to a nerve, the part of body connected to that nerve may get functionally impaired. ​​

Please click here for some guidelines on what to do on after your surgery. ​​ ​​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

 The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

 The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage ​
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The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.​