Introduction: Pilocytic astrocytoma is the most common brain tumor in childhood but knowledge concerning its long-term outcome is sparse. The aim of the study was to investigate if children treated for low-grade pilocytic astrocytoma in the posterior fossa had complications affecting physical health, cognition including executive function, language and academic performance. 

Methods: A descriptive single-center study, where 22 children and young adults out of 27 eligible patients (81%) treated for pilocytic astrocytoma in the posterior fossa, with a mean follow-up time of 12.4 years (5–19 years) participated (14 adults, 2 only by telephone interviews and 8 children). The study included a review of medical records, an interview, neurological investigation, a neuropsychological investigation, tests of language function and screening tools for academic performance in Swedish and mathematics. 

Results: 
Clinical outcome
Motor (mainly fine motor skills, n=12) and visual (mainly strabismus, n=5) complications were most common
 
Intelligence tests (WISC IV,WISC V and WAIS IV)
Full scale IQ: Mean value: 97 (min 71, max 122); 7 average, 7 below and 6 above average.
Verbal function: Mean value 93 (min 67, max 124); 9 average, 8 below and 2 above average (1 excluded)
Working memory: Mean value 100 (min 75, max 122); 7 average, 8 below and 5 five above average
Processing speed: Mean 97 (min 76, max 129); 10 average, 6 below and 4 above average.
Perceptual reasoning (WISC IV and WAIS ,n=16): Mean value: 108 ( min 68, max 134), 4 average, 4 below and 8 above average.

Behavior Rating Inventory of Executive function (BRIEF): Seventeen scored average results and 2 above.

Diagnostic tests in Swedish (DLS, Diagnostic material for analysis of reading and writing skills) and mathematics (Adler B Screening of mathematical skills) 
Word knowledge: Five scored below average and 3 above.
Reading speed: Six scored below average (2 of the participants were too young for the test).
Spelling:  Two scored below, 1 average and 4 above average (1 was excluded due to lack of time).
Reading comprehension: 5 scored below average, 1 average and 2 above.
Mathematics: Two scored below average, 2 average and 4 above.

Discussion: The long-term functional outcome for children treated for low-grade astrocytoma is favorable[1]. However, some patients report neurological complications and learning difficulties. Results from WISC IV/WAIS were within the mean with a scattered distribution. One third of the patients showed results below average in the full-scale IQ and they reported unmet difficulties in school. 
Results in the diagnostic tests in Swedish and mathematics showed most difficulties in word knowledge, reading speed and reading comprehension. 

Screening of executive function with BRIEF did not show any difficulties. There is need to further investigate executive functions using targeted tests. 

Conclusion: For children treated for pilocytic astrocytoma in the posterior fossa, there is a need to identify those who require more thorough medical and cognitive follow-up programs. 

A special educator can give additional information about educational strengths and difficulties for the pupil, leading to targeted interventions in school. 

Reference: 1.	Kristiansen, I., et al., Clinical characteristics, long-term complications and health-related quality of life (HRQoL) in children and young adults treated for low-grade astrocytoma in the posterior fossa in childhood. J Neurooncol, 2019.

Clinical Characteristics, Cognitive, Language and School Performance in Children and Young Adults Treated for Low-Grade Astrocytoma in the Posterior Fossa in Childhood