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Background: To determine whether the incidence and location of childhood CNS tumors in our patients follows the same pattern described in Western countries, we carried out this study. Materials and Methods: We analyzed the data compiled from 50 children less than 15 years old with brain tumors operated in Department of Neurosurgery in our hospital between 1994 and 2004. Diagnosis was made based on pathology and in some cases through imaging. Vascular and metastatic lesions were excluded and the latest WHO classification of brain tumor pathology was applied. Results: We found that 54% of all brain tumors were located in the supratentorial and 46% in the infratentorial region. Brain tumor was slightly more common in males (males 54% vs. females 46%). The most common tumor found in our patients was astrocytoma (43.9%), followed by meduloblastoma (26.8%), meningioma (14.6%), epandimoma (7.3%) craniopharyngioma (2.4%), epidermoid (2.4%) and dermoid(2.4%). However, in children between 5-10 years, meduloblastoma was the most common tumor. In this regards, the most common symptoms were headache and vomiting, respectively, whereas vomiting and increased head circumference were the most common ones in children under 5 years. The incidence in different age groups were as follows: 56% in 10-15 years old,28% in 5-9 years and 16% in under 5 years old. Astrocytoma was more common in female and meduloblastoma in male, relatively. Meningioma which has not been reported in western studies, was relatively common in our patients. Conclusion: In our patients, the incidence and distribution of CNS tumors were somewhat different from various reports of western countries. Whether there is any regional difference in disease distribution between Middle East and the rest of the world, remains to be determined.

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Background: Among children, there are several painful diagnostic or therapeutic procedures especially in malignant disease which may evoke fear and anxiety that may interfere with the treatment. Due to various reports on the efficacy of midazolam, we compared the effects of intranasal versus intravenous midazolam in reducing the pain, fear, and anxiety in children undergoing painful procedures at Loghman hospital between 2005-2006. Materials and Methods: This randomized clinical trial was conducted on two 30-participant groups of patients aged 4 15 years who were to underwent painful procedures (including bone marrow aspirations and lumbar punctures). One group received intravenous Midazolam and the other one did intranasal Midazolam before the procedures. Pain was measured based on Bieri facial pain scale, whereas anxiety was determined based on Yale-Pas scale. Fear was measured and analyzed between the two groups by Chi-square and fisher’s exact tests. Side affects were documented in both groups as well. Results: 50% of patients in the IV group, and 53.3% in the intranasal group had the Yale-PAS anxiety score of above 37, which was yielding a significant difference (P<0.9). 90% of the subjects in the intranasal group had mild pain while 10% had moderate one. In the IV group 74% experienced a mild pain and 25.9% suffered from moderate pain, whereas 10% experienced none at all. No significant difference was observed between the levels of pain amongst two groups (P<0.9). In both groups fear bacame less during and after the procedure and it was significantly decreased in intranasal group. Conclusion: Since the effect of intranasal and IV Midazolam on reducing the pain, anxiety, and fear is not significantly different, regarding the simplicity of intranasal administration, this approach may be of further compliance and more practicality for analgesia of painful procedures..