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Phillip B. Storm - One of the best experts on this subject based on the ideXlab platform.
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Cerebral Salt Wasting Syndrome in Post-Operative Pediatric Brain Tumor Patients
Neurocritical Care, 2012Co-Authors: Douglas A. Hardesty, Todd J. Kilbaugh, Phillip B. StormAbstract:Background Cerebral salt wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone (SIADH) are both causes of hyponatremia in Pediatric neurosurgical patients often with similar presenting symptoms; however, despite similar clinical characteristics the treatment for CSWS and SIADH can be drastically different, which makes the distinction critical for post-operative treatment. Further complicating matters, are the exact mechanism for CSWS which remains unclear, and the incidence and severity of CSWS is not well studied in Pediatric neurosurgical patients. We hypothesized that CSWS occurs frequently in post-operative Brain Tumor patients and is an important cause of post-operative hyponatremia in these patients. Methods We designed a single institution retrospective cohort study of all Pediatric Brain Tumor patients undergoing craniotomy for Tumor resection at our institution between January 2005 and December 2009. Results Of the 282 patients undergoing 291 operations, post-operative CSWS was identified in 15 cases (5%), and was more frequently observed than SIADH (nine cases, 3%). Median onset of CSWS was on post-operative day 3, lasting a median of 2.5 days. Patients with CSWS were more likely to have suffered post-operative stroke (40 vs. 4.6%, P
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cranial irradiation increases risk of stroke in Pediatric Brain Tumor survivors
Stroke, 2012Co-Authors: Cynthia J Campen, Phillip B. Storm, Peter C Phillips, Sarah M Kranick, Scott E Kasner, Sudha Kilaru Kessler, Robert A Zimmerman, Robert H Lustig, Sabrina E Smith, Rebecca IchordAbstract:Background and Purpose—The purposes of this study were to determine the incidence of neurovascular events as late complications in Pediatric patients with Brain Tumor and to evaluate radiation as a risk factor. Methods—Patients were ascertained using the Tumor database of a Pediatric tertiary care center. Included patients had a primary Brain Tumor, age birth to 21 years, initial treatment January 1, 1993, to December 31, 2002, and at least 2 visits with neuro-oncology. Radiation exposure included: whole Brain, whole Brain plus a focal boost, or focal Brain. The primary outcome was stroke or transient ischemic attack. Results—Of 431 subjects, 14 had 19 events of stroke or transient ischemic attack over a median follow-up of 6.3 years. The incidence rate was 548/100 000 person-years. Overall, 61.5% of subjects received radiation, including 13 of 14 subjects with events. Median time from first radiation to first event was 4.9 years. The stroke/transient ischemic attack hazard ratio for any Brain irradiation...
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Cerebral salt wasting syndrome in post-operative Pediatric Brain Tumor patients.
Neurocritical care, 2011Co-Authors: Douglas A. Hardesty, Todd J. Kilbaugh, Phillip B. StormAbstract:Background Cerebral salt wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone (SIADH) are both causes of hyponatremia in Pediatric neurosurgical patients often with similar presenting symptoms; however, despite similar clinical characteristics the treatment for CSWS and SIADH can be drastically different, which makes the distinction critical for post-operative treatment. Further complicating matters, are the exact mechanism for CSWS which remains unclear, and the incidence and severity of CSWS is not well studied in Pediatric neurosurgical patients. We hypothesized that CSWS occurs frequently in post-operative Brain Tumor patients and is an important cause of post-operative hyponatremia in these patients.
Maru Barrera - One of the best experts on this subject based on the ideXlab platform.
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a novel approach to understanding social behaviors in Pediatric Brain Tumor survivors a pilot study
Journal of Pediatric Psychology, 2021Co-Authors: Leandra Desjardins, Ute Bartels, Mengchuan Lai, Jacob A S Vorstman, Maru BarreraAbstract:Background/objectives Pediatric Brain Tumor survivors (PBTS) are at risk of experiencing challenges in social adjustment. However, the specific social behaviors of PBTS have rarely been directly assessed. This pilot study explores the first novel use of the Autism Diagnostic Observation Schedule, second edition (ADOS-2), to evaluate the social behaviors of PBTS. Methods Twenty-six PBTS (ages 9-17 years; M = 7.8 years from diagnosis; 52% male; 41% received radiation treatment) completed the ADOS-2. The proportion of the sample experiencing impairment was examined descriptively across all items of the ADOS-2, as well as by a summary "overall score" created for this study, and using the ADOS-2 "diagnostic algorithm" scores for autism. Social adjustment, cognitive, medical, and demographic variables were explored as correlates of the ADOS-2 "overall score". Results Study recruitment was 34%, impeded by distance from the tertiary-care center. The percentage of PBTS experiencing detectable impairments ranged from 0% to 50% across ADOS-2 items. Cranial radiation treatment, lower IQ, and slower cognitive processing were associated with higher impairment on the ADOS-2 "overall score". Conclusion The ADOS-2 can be used to assess the discrete social behaviors of PBTS. This study provides a foundation for future investigations using the ADOS-2 to assess social behaviors in this population. Identifying specific social behavior difficulties in PBTS is key to refining much needed targeted social skills interventions for this population.
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executive functions and social skills in Pediatric Brain Tumor survivors
Applied neuropsychology. Child, 2020Co-Authors: Leandra Desjardins, Aden Solomon, Laura Janzen, Ute Bartels, Fiona Schulte, Joanna Chung, Danielle Cataudella, Andrea Downie, Maru BarreraAbstract:Pediatric Brain Tumor survivors (PBTSs) may experience impairment in executive functions and social competence, but their interrelation is not well understood. This study aimed to address the speci...
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predicting social withdrawal anxiety and depression symptoms in Pediatric Brain Tumor survivors
Journal of Psychosocial Oncology, 2019Co-Authors: Leandra Desjardins, Laura Janzen, Ute Bartels, Fiona Schulte, Joanna Chung, Danielle Cataudella, Maru Barrera, Andrea DownieAbstract:AbstractObjective: Pediatric Brain Tumor survivors (PBTSs) are at risk for impairments in social adjustment and psychological distress. This study investigated longitudinal associations between sym...
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a randomized control intervention trial to improve social skills and quality of life in Pediatric Brain Tumor survivors
Psycho-oncology, 2018Co-Authors: Maru Barrera, Laura Janzen, Ute Bartels, Fiona Schulte, Joanna Chung, Danielle Cataudella, Eshetu G Atenafu, Lillian Sung, Kelly Hancock, Amani SalehAbstract:Background To determine if a group social skills intervention program improves social competence and quality of life (QOL) in Pediatric Brain Tumor survivors (PBTS). Methods We conducted a randomized control trial in which PBTS (8-16 years old, off therapy for over 3 months) were allocated to receive social skills training (eg, cooperation, assertion, using social cognitive problem solving strategies, role playing, games, and arts and crafts) in 8 weekly 2-hour sessions, or an attention placebo control (games and arts and crafts only). Outcomes were self-reported, proxy-reported (caregiver), and teacher-reported using the Social Skills Rating System (SSRS), to measure social competence, and the Pediatric Quality of Life (PedsQL4.0, generic) to measure QOL at baseline, after intervention, and at 6 months follow-up. At baseline, SSRS were stratified into low and high scores and included as a covariate in the analysis. Results Compared to controls (n = 48), PBTS in the intervention group (n = 43) reported significantly better total and empathy SSRS scores, with improvements persisting at follow-up. The PBTS in the intervention group who had low scores at baseline reported the greatest improvements. Proxy and teacher reports showed no intervention effect. Conclusions Participating in group social skills intervention can improve self-reported social competence that persisted to follow up. The PBTS should be given the opportunity to participate in social skills groups to improve social competence.
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social self perception among Pediatric Brain Tumor survivors compared with peers
Journal of Developmental and Behavioral Pediatrics, 2014Co-Authors: Christina G Salley, Maru Barrera, Cynthia A Gerhardt, Mary Jo Kupst, Andrea Farkas Patenaude, Diane L Fairclough, Kathryn VannattaAbstract:Brain Tumors are the second most common form of Pediatric cancer and advances in diagnostic techniques and treatment protocols have led to 5-year survival rates that now approach 74%.1 The sensitive location of these Tumors, as well as the necessity for treatments that penetrate the central nervous system (CNS) increase risk for neurocognitive deficits and psychosocial difficulties. However, questions often arise about the best methods and sources of data to use when describing the outcomes of these children.2 Although self-report of psychosocial outcomes and quality of life are typically obtained in adult cohorts, information about children’s functioning is often obtained from other sources. This may reflect challenges in data collection from children including concerns about the ability of children to provide accurate self-report data and the availability of reliable and valid child report measures. Self-report accuracy, or discrepancy from how one is perceived by others, is particularly concerning for children following treatment for a Brain Tumor due to the high possibility that children have experienced neurological and cognitive impairments.2 Thus, experts recommend obtaining assessments of children from multiple sources and examining intersource agreement.3 Although studies examining intersource agreement typically analyze concordance or correlation between measures, an alternative strategy is to use discrepancy scores.3 Discrepancies between self and others' ratings of specific attributes have been used to examine variations in self-perception accuracy among typically developing children.4 While high levels of agreement between sources may increase confidence in children’s self-report, it has been noted that diminished concordance does not necessarily suggest that one source is more valid than another; rather each source may provide unique, valuable contributions to the measurement of a particular construct. Systematic discrepancies in reports from different sources may help illustrate differences in perspectives or access to different domains of information that could inform education and intervention approaches. Using both concordance and discrepancies to examine accuracy may be useful in order to assess agreement between sources as well as the magnitude of differences between sources. A key area of quality of life that is adversely affected for children treated for Brain Tumors is social behavior and acceptance in the peer group.5,6 However, we know little about Brain Tumor survivors’ self-perceptions of their social competence and even less about the extent of concordance or discrepancies between self-perceptions and the reports of others. Some studies have reported consistent patterns of results using data provided by self and others’ reports of social difficulties. For example, Aarsen and colleagues5 found that social problems were endorsed by parents, teachers, and children. Likewise, Vannatta et al.7 reported that Brain Tumor survivors were more socially isolated than comparison peers according to peer, teacher, and self-report. However, in at least two studies, mothers of Brain Tumor survivors reported that their children had less social competence and more social problems than normative peers, but this was not reported by teachers and children themselves.8,9 These studies suggest that parents, particularly mothers, may-over report symptoms and difficulties, that Brain Tumor survivors may under-report problems, or that both may be true. Typically developing children follow a predictable pattern of self-perception development. As children age, they are able to process more complex information which typically improves self-perception accuracy. During early to middle childhood (e.g., 5-8), children frequently provide inflated reports of abilities. However, by middle to late childhood, children begin to incorporate both positive and negative information regarding the self.10 Children use social comparison to assess their behaviors and competencies in reference to those of peers and integrate this information to develop more accurate and differentiated perceptions of themselves.10,11 By mid-adolescence self-perceptions become fairly stable. Self-perceptions may differ across domains for males and females but self-perception accuracy, or concordance between reports, may be similar for typically developing males and females.12 Pediatric Brain Tumors and their treatment (CNS-directed chemotherapy, cranial radiation, and neurosurgery, alone or in combination) may interfere with the development of these self-perception skills. Such treatments have been associated with neurocognitive deficits including declines in IQ, working memory deficits, slower processing speed, and attentional problems.13 Research also suggest that females may be at greater risk for neurocognitive impairments than their male counterparts.14 Neurocognitive deficits have been linked to underestimation of social problems in children with learning disabilities or attention deficit/hyperactivity disorder when compared to teacher or peer report.15,16 It is unclear, however, if Pediatric Brain Tumor survivors demonstrate similar patterns of social self-perception or self-perception accuracy and if this may be more pronounced for females. Methodologically, examination of either inter-source agreement or discrepancies are strongest when self and other report data are collected using parallel forms and the reporting source is carefully selected. When choosing “other” informants, the research question must take into consideration the reliability and validity of that source with respect to the domain assessed. Further, reductions in response biases may be achieved by using multiple informants rather than a single source when possible.3 When examining accuracy of self-perception for social behaviors, classmates may be the best informants regarding a child’s actual social behavior in the peer group. Classmates have more opportunity to interact with and observe a child in social settings compared to parents who most often observe behaviors at home, or teachers who may typically focus on behaviors related to academic performance. Information from a group of children may also give better insight into a child’s general behavior by reducing bias from any single observer. The aim of this study was to examine the accuracy of social self-perceptions of children treated for Brain Tumors relative to demographically similar comparison classmates matched for gender, race, and age. Results from this data set have been reported elsewhere indicating that Brain Tumor survivors and comparison classmates differed on multiple dimensions of social behavior; however, these differences were consistently found for peer reported data and not self-report.17 Peers reported that survivors demonstrated less leadership and popularity but more sensitive-isolated behaviors and victimization than comparison classmates. Our primary hypothesis was that Brain Tumor survivors’ self-perceptions would be less accurate than those of comparison classmates. This was investigated by examining both levels of concordance and discrepancies between self and peer reports of social behavior. We expected that correlations between self and peer reports of specific dimensions of social behavior would be weaker for Brain Tumor survivors than comparison classmates and that the magnitude of discrepancies between self and peer reports would be greater for Brain Tumor survivors. We explored the direction of the inaccuracy, as well as factors (i.e., gender and IQ) which may be associated with self-perception accuracy. We expected that female survivors would demonstrate lower concordance and greater discrepancies than male survivors due to greater cognitive impairment as measured by IQ.
Lamia P. Barakat - One of the best experts on this subject based on the ideXlab platform.
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friendships in Pediatric Brain Tumor survivors and non central nervous system Tumor survivors
Journal of Pediatric Psychology, 2020Co-Authors: Matthew C. Hocking, Lamia P. Barakat, Robert B Noll, Anne E Kazak, Peter C Phillips, Cole BrodskyAbstract:OBJECTIVE Brain Tumors during childhood may disrupt the development and maintenance of friendships due to the impact of disease- and treatment-related factors on functioning. The goal of this study was to determine if children treated for either a Brain Tumor or a non-central nervous system (CNS) solid Tumor could name a friend and to evaluate the social information processes associated with the ability to name a friend. METHOD Youth (ages 7-14) treated for either a Brain Tumor (n = 47; mean age = 10.51 years) or a non-CNS solid Tumor (n = 34; mean age = 11.29) completed an assessment within 6 months of the conclusion of treatment that included asking participants to name a friend and completing measures of social information processing (SIP). Rates of self-reported friendship were compared between groups and correlates of being able to name a friend were evaluated. RESULTS Youth treated for a Brain Tumor (61.7%) were significantly less likely to name a friend compared with youth treated for a non-CNS solid Tumor (85.3%). Diagnosis type (Brain vs. non-CNS), relapse status, attribution style, and facial affect recognition were significant predictors of being able to name a friend or not in a logistic regression model. CONCLUSIONS Youth treated for a Brain Tumor and those who experienced a disease relapse are at risk for impairments in friendships; difficulties with SIP may increase this risk. Targeted screening and intervention efforts for children diagnosed with Brain Tumors and those who have relapsed could address difficulties with peers.
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Acceptability and Feasibility in a Pilot Randomized Clinical Trial of Computerized Working Memory Training and Parental Problem-Solving Training With Pediatric Brain Tumor Survivors.
Journal of pediatric psychology, 2019Co-Authors: Matthew C. Hocking, Iris Paltin, Lauren F. Quast, Lamia P. BarakatAbstract:OBJECTIVE To evaluate the feasibility and acceptability of computerized working memory training in Pediatric Brain Tumor survivors (PBTS) with cognitive deficits, as well as computerized working memory training that is enhanced with parental problem-solving skills training (PSST). METHODS Twenty-seven PBTS (ages 7-16) recruited from a large, tertiary academic medical center were randomly assigned to computerized working memory training (Standard; n = 14) or computerized working memory training plus PSST (Combined; n = 13). PBTS completed a baseline assessment and parents completed acceptability surveys. Primary outcomes included number of intervention sessions completed and acceptability ratings. RESULTS Fourteen of the 27 participants completed at least 20 sessions of the computerized training with average sessions lasting over an hour (M = 68.42 min, SD = 14.63). Completers had significantly better baseline auditory attention abilities than noncompleters. Parents reported both frustration and satisfaction related to the interventions and identified barriers to completing intervention sessions. CONCLUSIONS This pilot randomized clinical trial raises significant questions related to the feasibility of computerized working memory training in PBTS with cognitive deficits. Findings also offer considerations for integrating family-based treatment approaches into cognitive remediation interventions for PBTS.
Donald J Mabbott - One of the best experts on this subject based on the ideXlab platform.
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exercise trials in Pediatric Brain Tumor a systematic review of randomized studies
Journal of Pediatric Hematology Oncology, 2021Co-Authors: Bhanu Sharma, Donald J Mabbott, David J Allison, Patricia Tucker, Brian W TimmonsAbstract:In Pediatric Brain Tumor patients, treatment advances have increased survival rates to nearly 70%, while consequently shifting the burden of disease to long-term management. Exercise has demonstrated potential in improving multiple health impairments secondary to Brain Tumor treatment. However, these effects have not been consolidated through review. Therefore, we performed a systematic review of 6 health sciences databases (Medline, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Central Database). Two reviewers screened studies against predefined inclusion criteria, namely that the study must: (i) be Pediatric-specific; (ii) examine the effects of an exercise intervention; and (iii) employ a randomized or quasi-randomized trial design. The same 2 reviewers performed data extraction and analyses. From a pool of 4442, 5 articles-based on 2 independent trials-were included in our review (N=41). Exercise interventions were primarily aerobic, but included balance or muscle building components. Exercise had a positive effect on volumetric or diffusion-based neuroimaging outcomes, as well as motor performance and cardiorespiratory fitness. The effects of exercise on cognition remains unclear. Exercise did not worsen any of the outcomes studied. This review captures the state of the science, suggesting a potential role for exercise in children treated for Brain Tumor.
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a controlled clinical crossover trial of exercise training to improve cognition and neural communication in Pediatric Brain Tumor survivors
Clinical Neurophysiology, 2020Co-Authors: Elizabeth Cox, Sonya Bells, Suzanne Laughlin, Eric Bouffet, Brian W Timmons, Cynthia De Medeiros, Kiran Beera, Diana Harasym, Donald J MabbottAbstract:Abstract Objective To assess the efficacy of aerobic exercise training to improve controlled attention, information processing speed and neural communication during increasing task load and rest in Pediatric Brain Tumor survivors (PBTS) treated with cranial radiation. Methods: Participants completed visual-motor Go and Go/No-Go tasks during magnetoencephalography recording prior to and following the completion of 12-weeks of exercise training. Exercise-related changes in response accuracy and visual-motor latency were evaluated with Linear Mixed models. The Phase Lag Index (PLI) was used to estimate functional connectivity during task performance and rest. Changes in PLI values after exercise training were assessed using Partial Least Squares analysis. Results: Exercise training predicted sustained (12-weeks) improvement in response accuracy (p
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disrupted network connectivity in Pediatric Brain Tumor survivors is a signature of injury
The Journal of Comparative Neurology, 2019Co-Authors: Samantha Gauvreau, Jeremie Lefebvre, Sonya Bells, Suzanne Laughlin, Eric Bouffet, Donald J MabbottAbstract:Cognition is compromised in Pediatric Brain Tumor survivors but the neurophysiological basis of this compromise remains unclear. We hypothesized that reduced neural synchronization across Brain networks is involved. To test this, we evaluated group differences using a retrospective cohort comparison design between 24 Pediatric Brain Tumor survivors [11.81 ± 3.27)] and 24 age matched healthy children [12.04 ± 3.28)] in functional connectivity within a cerebellar network to examine local effects of the Tumor, a whole Brain network to examine diffuse effects of treatment (i.e., chemotherapy and radiation), and across multiple intrinsic connectivity networks. Neural activity was recorded during magnetoencephalography scanning while participants were at rest and functional connectivity within networks was measured using the phase lag index. We corroborated our findings using a computational model representing the local Tumor effects on neural synchrony. Compared to healthy children, Pediatric Brain Tumor survivors show increased functional connectivity for theta and beta frequency bands within the cerebellar network and increased functional connectivity for the theta band within the whole Brain network that again localized to the cerebellum. Computational modeling showed that increased synchrony in the theta bad is observed following local clustering as well as sparse interarea Brain connectivity. We also observed increased functional connectivity for the alpha frequency band in the ventral attention network and decreased functional connectivity within the gamma frequency band in the motor network within paedatric Brain Tumor survivors versus healthy children. Notably, increased gamma functional connectivity within the motor network predicted decreased reaction time on behavioral tasks in Pediatric Brain Tumor survivors. Disrupted network synchrony may be a signature of neurological injury and disease.
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repairing the Brain with physical exercise cortical thickness and Brain volume increases in long term Pediatric Brain Tumor survivors in response to a structured exercise intervention
NeuroImage: Clinical, 2018Co-Authors: Kamila U Szulclerch, Suzanne Laughlin, Eric Bouffet, Brian W Timmons, Cynthia B De Medeiros, Jovanka Skocic, Jason P Lerch, Donald J MabbottAbstract:There is growing evidence that exercise induced experience dependent plasticity may foster structural and functional recovery following Brain injury. We examined the efficacy of exercise training for neural and cognitive recovery in long-term Pediatric Brain Tumor survivors treated with radiation. We conducted a controlled clinical trial with crossover of exercise training (vs. no training) in a volunteer sample of 28 children treated with cranial radiation for Brain Tumors (mean age = 11.5 yrs.; mean time since diagnosis = 5.7 yrs). The endpoints were anatomical T1 MRI data and multiple behavioral outcomes presenting a broader analysis of structural MRI data across the entire Brain. This included an analysis of changes in cortical thickness and Brain volume using automated, user unbiased approaches. A series of general linear mixed effects models evaluating the effects of exercise training on cortical thickness were performed in a voxel and vertex-wise manner, as well as for specific regions of interest. In exploratory analyses, we evaluated the relationship between changes in cortical thickness after exercise with multiple behavioral outcomes, as well as the relation of these measures at baseline. Exercise was associated with increases in cortical thickness within the right pre and postcentral gyri. Other notable areas of increased thickness related to training were present in the left pre and postcentral gyri, left temporal pole, left superior temporal gyrus, and left parahippocampal gyrus. Further, we observed that compared to a separate cohort of healthy children, participants displayed multiple areas with a significantly thinner cortex prior to training and fewer differences following training, indicating amelioration of anatomical deficits. Partial least squares analysis (PLS) revealed specific patterns of relations between cortical thickness and various behavioral outcomes both after training and at baseline. Overall, our results indicate that exercise training in Pediatric Brain Tumor patients treated with radiation has a beneficial impact on Brain structure. We argue that exercise training should be incorporated into the development of neuro-rehabilitative treatments for long-term Pediatric Brain Tumor survivors and other populations with acquired Brain injury. (ClinicalTrials.gov, NCT01944761).
Douglas A. Hardesty - One of the best experts on this subject based on the ideXlab platform.
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Cerebral Salt Wasting Syndrome in Post-Operative Pediatric Brain Tumor Patients
Neurocritical Care, 2012Co-Authors: Douglas A. Hardesty, Todd J. Kilbaugh, Phillip B. StormAbstract:Background Cerebral salt wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone (SIADH) are both causes of hyponatremia in Pediatric neurosurgical patients often with similar presenting symptoms; however, despite similar clinical characteristics the treatment for CSWS and SIADH can be drastically different, which makes the distinction critical for post-operative treatment. Further complicating matters, are the exact mechanism for CSWS which remains unclear, and the incidence and severity of CSWS is not well studied in Pediatric neurosurgical patients. We hypothesized that CSWS occurs frequently in post-operative Brain Tumor patients and is an important cause of post-operative hyponatremia in these patients. Methods We designed a single institution retrospective cohort study of all Pediatric Brain Tumor patients undergoing craniotomy for Tumor resection at our institution between January 2005 and December 2009. Results Of the 282 patients undergoing 291 operations, post-operative CSWS was identified in 15 cases (5%), and was more frequently observed than SIADH (nine cases, 3%). Median onset of CSWS was on post-operative day 3, lasting a median of 2.5 days. Patients with CSWS were more likely to have suffered post-operative stroke (40 vs. 4.6%, P
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Cerebral salt wasting syndrome in post-operative Pediatric Brain Tumor patients.
Neurocritical care, 2011Co-Authors: Douglas A. Hardesty, Todd J. Kilbaugh, Phillip B. StormAbstract:Background Cerebral salt wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone (SIADH) are both causes of hyponatremia in Pediatric neurosurgical patients often with similar presenting symptoms; however, despite similar clinical characteristics the treatment for CSWS and SIADH can be drastically different, which makes the distinction critical for post-operative treatment. Further complicating matters, are the exact mechanism for CSWS which remains unclear, and the incidence and severity of CSWS is not well studied in Pediatric neurosurgical patients. We hypothesized that CSWS occurs frequently in post-operative Brain Tumor patients and is an important cause of post-operative hyponatremia in these patients.