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Background: Treatment of childhood brain tumours requires coordinated efforts by multiple specialities - neurosurgery, neuroradiology, neuropathology, oncology, and radiotherapy. The outcome is worse in developing countries compared to developed countries because of deficiencies in proper registry, failure of timely diagnosis, lack of availability and co-ordination of multiple specialists required for comprehensive management and high abandonment rates. Method: The pediatric neuro-oncology program was initiated in collaboration with the neighbouring neurosurgery institution as a step towards improving care for pediatric brain tumor patients in our hospital. Epidemiology, treatment and followup of brain tumours in children aged 1-14 years attending the pediatric oncology department were studied. Patients received multimodality treatment with surgery, radiotherapy and chemotherapy by specialists in both centres. The study period was from January 2008 to December 2012. Results: There were 375 pediatric brain tumour patients during the study period. 166 patients (44.2%) had supratentorial tumors and 209 (55.73%) had infratentorial tumors. 42.6% of tumours were high-grade and 53.6% were low grade. The commonest histopathological tumour type was astrocytoma (48.8%) followed by medullobastoma (24.5%). 287 (76.5%) patients underwent surgery, 216 (57.6%) patients received radiotherapy, 97 (25.8%) patients received chemotherapy and 94 (25%) required follow-up only. Patient follow-up rates improved from 37.2% to 82.6% and treatment abandonment decreased from 35.8% to 14.8% over these years. Conclusions: Impact of the pediatric neuro-oncology program in our hospital has made it possible to provide comprehensive multidisciplinary treatment in a co-ordinated manner, describe the epidemiology of pediatric brain tumors, reduce treatment abandonment, and improve the follow-up of pediatric brain tumour patients.

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Osmotic myelinolysis is an acute, rare, demyelinating process. After the initial description of the condition by Adam and colleagues in 1959, many case series have been published describing the central and extrapontine myelinolysis. Imaging has a definitive role in establishing the diagnosis of osmotic myelinolysis in vivo and diffusion-weighted imaging reveals earliest changes in affected brain parenchyma. We report two cases of patients with proven malignancy who developed extrapontine myelinolysis after treatment for hyponatremia and progressed to central pontine myelinolysis within a week. This was confirmed with magnetic resonance (MR) imaging and clinical assessment. This temporal progression of MR features, especially on diffusion-weighted imaging, from extrapontine to central pontine myelinolysis in osmotic injury has not been described in literature to the best of our knowledge. An early MRI of the brain in suspected/high-risk cases of osmotic myelinolysis may show features of extrapontine myelinolysis in the form of restricted diffusion in bilateral basal ganglia and may serve as a guide for predicting progression, prognosticating and deciding further treatment of pontine myelinolysis. We propose that in a significant number of cases, central pontine myelinolysis may be predicted by doing an early MRI of the brain with diffusion-weighted imaging, when extrapontine symptoms start to develop. This can potentially increase the window period and possibilities for therapeutic intervention and may even help in prevention.