Posterior cranial fossa tumours in children at Kenyatta National Hospital, Nairobi

Abstract

Background: The management of children with posterior fossa tumours is a challenge to health care professionals worldwide. Difficulties in diagnosis especially in children less than three years is well documented. Limited diagnostic modalities and lack of awareness of the symptoms and signs as well as societal perception of children's complaints contributes to late presentation. Kenyatta National Hospital Neurosurgical unit is the only specialized unit among the public hospitals in Kenya where such patients are referred. Objective: To review the management of posterior fossa tumours in children at Kenyatta National Hospital. Design: A retrospective analysis of children treated for posterior fossa tumours at the neurosurgical unit of Kenyatta National Hospital between 1996-2003. Setting: Neurosurgery unit, Kenyatta National Teaching and Referral hospital. Results: Thirty seven children were treated for posterior fossa tumours between 1998 and 2003. Twenty four were females while thirteen were males giving a male: female ratio of 1:1.8. The age varied between 2-16 years with a mean of 6.7 years. Cerebellar symptoms were the most common mode of presentation (30%) followed by headaches and vomiting. Twenty percent of our patients were blind at presentation probably due to chronic effects of raised intracranial pressure. Out of 11 patients with histological diagnosis of meduloblastomas, over 99%, were females and only one was a male. Astrocytomas were evenly distributed at five males and six females. The mean duration of symptoms was 3.7 months while it took eight weeks between time of diagnosis and treatment. Conclusion: Posterior fossa tumours in our set-up are more common in females than in males, M:F ratio of 1:1.8. Over 90% of medulloblastomas are found in female children making it a predominantly female tumour as opposed to available literature. The delay in diagnosis is probably due to lack of information both to the parents and health care providers and expensive diagnostic tools. A high index of suspicion, and a good history and clinical examination is required in the diagnosis of posterior fossa tumours in children especially those below three years.