Pediatric Brain Tumors

Some pediatric brain tumors are noncancerous (benign), and some pediatric brain tumors are cancerous (malignant).
Symptoms:

  • Headache.
  • Vomiting (usually in the morning).
  • Nausea.
  • Personality changes.
  • Irritability.
  • Drowsiness.
  • Depression.
  • Seizures.
  • Visual changes.
  • Slurred speech.
  • Paralysis or weakness on half of the body or face.
  • Drowsiness and/or confusion.
  • Personality changes.

Diagnosis of a brain tumor depends mostly on the types of cells in which the tumor begins and the tumor location:

  • Neurological exam.
  • Computerized tomography scan (CT)
  • Magnetic resonance imaging (MRI)
  • Electroencephalography (EEG)
  • Lumbar puncture (cerebral spinal fluid (CSF) testing)

The common types of brain tumors:

  • Astrocytomas. The most common location of these tumors is in the cerebellum, where they are called cerebellar astrocytomas. These persons usually have symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination, as well as double vision.
  • Brain stem gliomas. Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.
  • Ependymomas. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing increased intracranial pressure. This type of tumor mostly occurs in children younger than 10 years of age. Ependymomas can be slow growing, compared to other brain tumors, but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment.
  • Medulloblastomas. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually needed to control these tumors.

Treatment may include (alone or in combination):

  • Surgery – Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible while maintaining neurological function. Surgery for a biopsy is also done to examine the types of cells the tumor is made of for a diagnosis. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured during removal.
  • Chemotherapy (Chem.th)
  • Radiation therapy (XRT)
  • Steroids (to treat and prevent swelling especially in the brain)
  • Anti-seizure medication (to treat and prevent seizures associated with intracranial pressure)
  • Ventriculoperitoneal (VP) shunt – A shunt may be placed in the head to drain excess fluid from inside the brain. A VP shunt helps control the pressure inside the brain.

References.

1. Buckner JC, Brown PD, O’Neill BP, Meyer FB, Wetmore CJ, Uhm JH. Central nervous system tumors. Mayo Clin Proc. 2007;82(10):1271-1286.
2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Central nervous system cancers. V.2.2009.
3. Wilne S, Koller K, Collier J, Kennedy C, Grundy R, Walker D. The diagnosis of brain tumours in children: a guideline to assist healthcare professionals in the assessment of children who may have a brain tumour. Arch Dis Child. 2010;95:534-539.