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- Seizures most common symptom: Seizures are the most common presenting symptom, usually long-lasting seizures that were not investigated by imaging at their onset.
- Occasionally, symptoms due to elevated ICP: Less frequently, patients may develop intracranial hypertension.
- Focal neurological deficits unusual
Patterns of evolution
- Seizures: Because seizures usually are the first presenting symptom, the tumor is most often diagnosed with imaging following seizures.
Time for evolution
- Slow: Usually PXAs are slow-growing tumors unless the tumor is an anaplastic variant.
Intervention at Presentation
- Seizure: Antiseizure medication is used to manage the presenting complaint.
Preparation for definitive intervention, nonemergent
- Imaging: MRI should be done.
- Plan surgery: After imaging, a surgical approach can be chosen and the case discussed with the parents. Surgery can be done as a semi-elective case in the OR.
Preparation for definitive intervention, emergent
- Manage hydrocephalus: In rare cases, if the tumor is large enough or causes hydrocephalus by blocking CSF pathways, then hydrocephalus has to be dealt with (i.e., EVD or direct removal of the tumor).
- Imaging: Imaging should be done. If the child’s condition is unstable, a CT scan will suffice to assess the pathology and the hydrocephalus.
- Routine: Standard admission orders are used in preparing the child for surgery.