COMMON BRAIN TUMORS IN CHILDREN |
Tumor Location by Age
Age |
Supratentorial |
Infratentorial |
< 2 yrs |
75% |
25% |
2-10 yrs |
40% |
60% |
10-20 |
60% |
40% |
Adult |
75% |
25% |
|
Pediatric CNS Tumor Histology
●
Supratentorial gliomas 30% - 35%
●
Primitive neuroectodermal tumor 20 -25%
●
Cerebellar juvenile pilocytic astrocytoma 15%
●
Brainstem gliomas 15%
●
Ependymoma 15% 5%
●
Choroid plexus papilloma 10%
●
Craniopharyngiomas 5%
●
Pineal region tumors 5%
●
Spinal canal 5%
●
Rhabdoid tumors 5%
|
Supratentorial Glioma |
Two-thirds of tumors are low-grade Half of the
low-grade tumors are astrocytomas; half have more exotic
pathology.
If the tumors are resectable some can be
cured Prognosis depends upon tumor histology, tumor
location, and extent of resection Children with
malignant tumors and maximal therapy survive 1-3 years.
|
Primitive Neuroectodermal Tumors |
Malignant tumors that occur throughout the CNS with
similar histology and prognosis, but that were given
different names in the past depending on location
Medulloblastomas arise in the fourth ventricle, and
comprise 30% of posterior fossa tumors of childhood
Medulloblastoma is the most common malignant brain tumor
of childhood
Medulloblastomas occur in adults
infrequently
The 5 year survival of pediatric medulloblastoma has improved to about 70%, on the basis
of complete surgical resection and adjuvant therapy
which usually includes craniospinal radiation (because
of the strong tendency of medulloblastoma to seed the
subarachnoid space) and often chemotherapy.
|
Juvenile Pilocytic Astrocytoma |
Tumors occur in the cerebellar hemispheres, frequently
with cysts
Gross total resection can cure >95% in the
posterior fossa
Pathology is WHO grade I, the same
pathology as optic and hypothalamic astrocytomas
In
contrast to cerebellar astrocytomas, astrocytomas of the
optic apparatus and hypothalamus are generally not
amenable to gross total resection.
|
Brainstem Glioma |
Diffusely infiltrative unresectable tumors that show a
poor response to radiation and chemotherapy
Some
midbrain tectal gliomas remain dormant but may cause
obstructive hydrocephalus Pontine tumors usually
present with long tract symptoms and signs and cranial
palsies, but not hydrocephalus Pathology can vary from
WHO I to IV, but the prognosis is typically dismal
(almost all die by 18 months after diagnosis).
|
Ependymoma |
Malignant tumor that often arises in the posterior fossa,
but is found throughout the CNS Tumor tends to extrude
through the outlets of the fourth ventricle and encase
cranial nerves and vessels Typically present with
symptoms of obstructive hydrocephalus, but frequently
have lower cranial nerve palsies after resection The
prognosis is generally significantly worse than that for medulloblastoma. With complete resection and radiation,
survival may reach 40% at 5 years. Chemotherapy is not
effective. Late recurrences occur. |