NS-09: NARCOLEPSY AND BRAIN TUMORS: PRESENTATION AND EVOLUTION

We report an unusual case of an 11 year-old girl presenting narcolepsy in addition to growth failure and behavioral changes related to a large sellar and suprasellar germinoma. We aim to determine the clinical presentation and evolution of narcolepsy associated with brain tumors. METHODS: An extensive review of the literature was conducted to extract cases of narcolepsy associated with hypothalamic region brain tumors. RESULTS: A total of 24 cases were found in the literature, including 16 (67%) in children. Most patients developed narcolepsy after surgery, whereas 9/21 (42%) presented with narcolepsy prior to diagnosis. Most cases were secondary to craniopharyngioma (7/20, 35%), followed by glioma and adenoma (5/20, 25%). Only one patient had a germinoma and became symptomatic after surgery. Postoperative evolution was reported in fourteen patients. Two had a complete resolution of symptoms after treatment. Both patients were treated with biopsy and adjuvant therapy. For patients with persistent symptoms, most (70%) improved following medical management of narcolepsy. DISCUSSION: We present a unique case of narcolepsy related to a large germinoma. Although narcolepsy appears to be a rare complication of pediatric brain tumors with hypothalamic involvement, this peculiar condition might be under recognized and underreported. Most cases are secondary to surgically-induced damage to the hypothalamus. Patients that did not require extensive surgical resection appear to have a better outcome of narcolepsy symptoms. This study supports the importance hypothalamic-sparing and minimally invasive surgery for patients who response well to chemotherapy, since symptoms such as narcolepsy can resolve after tumor treatment.