Pediatric Central Nervous System Tumors in Nepal: Retrospective Analysis and Literature Review of Low- and Middle-Income Countries.
BACKGROUND
Central nervous system (CNS) tumors are the most common cause of cancer-related death in children. Little is known about the demographics and treatment of pediatric brain tumors in low- and middle-income countries (LMICs).


METHODS
We performed a retrospective chart review of all pediatric patients who presented to the neurosurgical service at Tribhuvan University Teaching Hospital in Kathmandu, Nepal from 2009-2014 and collected information on patients <18 years old who received a diagnosis of a CNS tumor. We analyzed age, gender, clinical presentation, extent of surgical resection, histopathology, and length of hospital stay. We also conducted a literature review using specific terminology to capture studies of pediatric neuro-oncologic epidemiology conducted in LMICs. Study location, length of study, sample size, study type, and occurrence of 4 common pediatric brain tumors were extracted.


RESULTS
We identified 39 cases of pediatric CNS tumors, with 62.5% observed in male children. We found that male children (median = 13 years) presented later than female children (median = 8 years). The most frequently observed pediatric brain tumor type was ependymoma (17.5%), followed by astrocytoma (15%) and medulloblastoma (15%). Surgical resection was performed for 80% of cases, and gross total resection reported in 62.9% of all surgeries. More than half (54.1%) of patients had symptoms for more than 28 days before seeking treatment. Symptomatic hydrocephalus was noted in 57.1% of children who presented with CNS tumors. The literature review yielded studies from 18 countries. Study length ranged from 2-20 years, and sample sizes varied from 35-1948. Overall, we found more pronounced variation in the relative frequencies of the most common pediatric brain tumors, compared with high-income countries.


CONCLUSIONS
We present the first operative series of childhood CNS tumors in Nepal. Children often had delayed diagnosis and treatment of a tumor, despite symptoms. More comprehensive data are required to develop improved treatment and management algorithms in the context of a given country's demographics and medical capabilities for childhood CNS tumors.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Tej D
TD
Azad
Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Ram Kumar
RK
Shrestha
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Silvia
S
Vaca
Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Ali
A
Niyaf
Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Amit
A
Pradhananga
Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Gopal
G
Sedain
Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Mohan R
MR
Sharma
Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Sushil K
SK
Shilpakar
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. Electronic address: ggrant2@stanford.edu.
Gerald A
GA
Grant
D000293:Adolescent; D001254:Astrocytoma / Q000453:epidemiology; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data*; D004806:Ependymoma / Q000453:epidemiology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D008297:Male; D008499:Medical Records; D008527:Medulloblastoma / Q000453:epidemiology; D009390:Nepal / Q000453:epidemiology; D012189:Retrospective Studies
Brain tumor; Epidemiology; Global surgery; Low-income country; Nepal; Pediatric