10 - Intracranial tumours - CCMTA Medical Standards
Intracranial tumours and medical fitness to drive.
10.1 About intracranial tumours
Intracranial tumours are tumours that develop inside the cranium, the upper portion of the skull that protects the brain. Primary tumours are those which originate from within the cranium and metastatic tumours are those which result from cancers which spread (metastasize) from other parts of the body. Metastatic tumours are by far the more common type of intracranial tumour in adults, 10 times more common than primary tumours.
Primary tumours may be classified as either benign (non-cancerous) or malignant (cancerous). Malignant tumours are graded on a scale of 1 to 4, with grade 4 being the most severe, based on how abnormal they are compared to normal tissue and how quickly they are likely to grow and metastasize.
Typically, the treatment options for intracranial tumours are surgery, radiation and chemotherapy, alone or in combination, regardless of whether the tumour is primary or metastatic, benign or malignant. For primary tumours, the probability of successful treatment depends on a number of factors, including the type of tumour, size and location.
Treatment will rarely cure a metastatic tumour, and the goal of treatment is generally to reduce symptoms, increase length of survival and improve quality of life.
Impairments associated with intracranial tumours vary depending on the tumour type, location and rate of growth, and can affect cognitive, motor or sensory functions.
Examples of possible impairments include:
- Cognitive impairment
- Personality changes
- Focal weakness, and
- Sensory disturbances
The presentation of impairments may be progressive or variable.
The overall incidence of intracranial tumours in the United States is between 5 and 14 per 100,000 people (all ages), with the peak incidence in those between 65 and 79 years of age. Canadian data are lacking.
10.3 Intracranial tumours and adverse driving outcomes
No studies on the effects of intracranial tumours on driving were found.
10.4 Effects on functional ability to drive
|Condition||Type of driving impairment and assessment approach||Primary functional ability affected||Assessment tools|
|Intracranial tumour||Persistent impairment: Functional assessment||Variable – cognitive, motor or sensory||
|Episodic impairment: Medical assessment – likelihood of impairment||Variable – sudden impairment (epilepsy)||Medical assessments|
An intracranial tumour may result in a persistent cognitive, motor or sensory impairment, or an episodic impairment (epilepsy), or both.
Drivers who have experienced a persistent impairment of motor or sensory function may be able to compensate. An occupational therapist, driver rehabilitation specialist, driver examiner or other medical professional may recommend specific compensatory vehicle modifications or restrictions based on an individual functional assessment.
Some examples of compensatory mechanisms are shown in the following table.
|Motor impairment||Sensory (vision) impairment|
10.6 Guidelines for assessment
If a driver has epilepsy as a result of an intracranial tumour, also see the standards in Chapter 17.
All drivers eligible for a licence if
|Conditions for maintaining licence||No conditions are required|
RoadSafetyBC may restrict an individual’s licence so that they only drive with any permitted vehicle modifications and devices required to compensate for their functional impairment. This may include one or more of the following restrictions
|Reassessment||RoadSafetyBC will re-assess every 5 years or in accordance with routine commercial or age-related re-assessment, unless a shorter re- assessment interval is recommended by the treating physician. No further re-assessment is required if the tumour is successfully removed|
|Information from health care providers||
|Rationale||The potential functional impairments associated with an intracranial tumour are variable|