Neuropsychiatry: Aspects of Childhood Cranial Tumours

More than 90 years have passed since Baily and Cushing first introduced a histogenetic classification for tumours of the cranial nervous system (CNS). More recently, our knowledge of the genetic and molecular basis of tumorigenesis has caused a major paradigm shift towards defining tumours genetically, thus allowing greater diagnostic accuracy and prognostication to better guide tumour management. Correspondingly, successes in integrated management and improved survival rates have shifted attention towards overall quality of life studies, where psychosocial sequelae and adjustment implications are of particular interest to mental health professionals. To date, research relevant to this field has focused on the identification of neuropsychiatric symptoms at manifestation of illness. Such studies indicate that mood, cognition and psychosocial functioning are important factors in early diagnosis, mediating health outcomes, especially following radical and risk-adapted anti-neoplastic treatment. In addition to psychological burden, the neuropsychiatric aspects of childhood CNS tumours, including posterior fossa syndrome and cerebellar cognitive affective syndrome, are increasingly recognised as crucial causes of poor outcomes. The chapter ahead will initially address the shifting landscape of neuro-oncology, and then provide an overview of the neuropsychiatric aspects of CNS tumours in childhood, highlighting the underlying neurobiological and pathogenic mechanisms, whenever possible