Support Services for Brain Tumor Patients

Ophthalmology Clinic
St. Jude Children's Research Hospital’s ophthalmology clinic  offers specialty care for patients with brain tumors and other cancers that affect the eye and visual pathway. Ophthalmology clinics are held daily in the St. Jude’s ophthalmic examination and diagnostic suite, and ophthalmic surgical procedures are performed onsite in St. Jude’s Department of Surgery.

The St. Jude Ophthalmology Clinic is a recognized authority in the diagnosis and management of ocular and orbital tumors, particularly retinoblastoma. It also offers expertise in ophthalmic tumors, neuro-ophthalmic disorders, ocular motor abnormalities with brain stem involvement, and paralytic ophthalmic disorders.

The ophthalmology service is dedicated to providing comprehensive ophthalmic care and collaborating with St. Jude researchers to pursue improved ways of diagnosing and treating cancers involving the eye and visual pathways.

Endocrine Services
Children and adolescents with brain tumors often require evaluation and treatment for endocrine system dysfunction. The endocrine system controls the body’s hormones.

St. Jude’s pediatric endocrine service  performs these services and conducts research on hormonal side effects and hormonal therapy after cancer treatment.

Common clinical problems include growth hormone deficiency, central hypothyroidism (a deficiency in the thyroid gland, a condition characterized by lowered metabolic rate and loss of vigor), delayed or precocious puberty, and obesity syndromes. The service’s research activities focus on:

Our patients are routinely referred to the endocrinologist who follows them on a regular basis. Specific therapy is initiated if and when it is necessary for a specific child.

Psychology
The Department of Psychology provides neuropsychological, psychosocial, religious, child life and school services. All patients receive a comprehensive neuropsychological evaluation at the time of admission and routinely thereafter to assess their developmental progress. The department is also actively engaged in research aimed at clarifying the adverse effects of brain tumors and their treatments, as well as the development of innovative techniques for patient rehabilitation.

Rehabilitation Services
Rehabilitation is extremely important to the recovery of children treated for brain tumors. Their quality of life is strongly influenced by the children's ability to communicate, function independently and participate in peer interactions, daily life and recreation. St. Jude’s physical and occupational therapists, orthotist, audiologist and speech pathologist help identify and treat children at high risk of physical problems. Evaluation may be formal or informal and may include any combination of standardized tests, musculoskeletal assessment, observation and reports by family or caregivers. Objectives and treatment plans are developed based on each patient’s needs. Together, the professionals in Rehabilitation Services contribute enormously to the quality of life and the future outlook of children treated for brain tumors.

Diagnostic Pathology
Expert review of biopsy tissue is crucial to the accurate diagnosis and appropriate treatment of childhood brain tumors. The Division of Anatomic Pathology provides a comprehensive review of the histopathologic, immunohistochemical and clinicopathologic characteristics of each tumor, with diagnostic imaging (MRI) correlation.

Magnetic Resonance Imaging
Children treated at St. Jude are evaluated by magnetic resonance (MR) imaging at frequent intervals during and after treatment. MR images show a remarkable detailed picture of the tumor and surrounding brain, which the St. Jude Brain Tumor Team discusses at weekly meetings that focus on each patient receiving therapy.

At. St. Jude, advanced techniques such as dynamic MR imaging, MR volumetry, MR spectroscopy and high resolution MR angiography are used to follow the response of the tumor and brain to therapy. This information can help in planning the best treatment strategy for individual patients, and may lead to a better understanding of the effects of treatment on the tumor and on the biology and function of the brain itself.

Neurosurgery
The pediatric brain tumor neurosurgery team is led by Robert A. Sanford, MD, and includes Michael Muhlbauer, MD, and Stephanie Einhaus, MD. Last year the team performed more than 100 operations for tumors of the central nervous system. In addition to their vital role in the treatment of brain tumors and involvement in prospective therapeutic studies, the neurosurgery team collaborates with St. Jude scientists in performing basic biologic research.

Surgery and immediate postoperative care is provided at Le Bonheur Children’s Hospital, located approximately one mile from St. Jude. Operating rooms are supplied with state-of-the-art technology including advanced microscopy, laser and ultrasonic aspiration. A new feature is a frameless stereotactic microscope that allows the surgeon to view a 3-dimensional map of the tumor superimposed on the surgical field. The system’s computer screen provides key information that helps the surgeon identify tumor margins. St. Jude is evaluating the use of the new technology as an aid to total tumor removal and in predicting tumor recurrence.

Dental Clinic
Dentistry is an important part of the medical service provided at St. Jude. New patients often have oral and dental problems requiring immediate attention so that proper medical treatment can proceed without delay or interruption. The main objective of the Dental Services is to work closely with the physicians and nurses of all the various departments in the treatment, prevention and study of oral problems that may arise from childhood diseases and/or complications of therapy.

Clinical Nutrition
Clinical Nutrition Services is a support department of St. Jude. Its primary areas of responsibility include:

Nutrition care is an integral part of a child’s medical care during cancer treatment. Many children need help with nutrition during their course of therapy. An individualized nutritional care plan may involve a special diet with counseling, use of high-calorie supplements to boost intake or a specialized nutritional feeding. The clinical nutritionists work closely with the health care team to plan the best nutritional program for each child.


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