Pediatric Brain Tumors

There are more than ________ types of pediatric brain tumors, and various treatment options are available for patients depending on their tumor type. Treatment plans are built through a collaborative approach between the Pediatric Neurosurgeon, Pathologist, Pediatric Oncologist and Radiation Oncologist. If surgery is indicated based on patient’s symptoms, tumor location and size, Dr. Thompson is fully equipped to handle even the most complex of tumor types. Surgical approaches and post-operative management are highly variable as tumor size, location and tumor type differ.

One of the key aspects of a craniotomy for brain tumor is getting a tissue diagnosis-a final pathology. The pathology may take 5 business days or longer to obtain. The specimen is often sent to outside facilities for specific genomic testing and a more precise tissue diagnosis so that treatment can be tailored as specifically as possible. Final pathology will then help determine the need for further treatment (i.e. radiation, chemotherapy, etc.) and will also help determine when follow up scans will be obtained.

 
 

Work up

Symptoms: Progressive neurological deficit, motor weakness, dysphasia, vision changes, headaches, seizures, AMS, lethargy, depression, nausea, vomitingImaging: MRI with and without gadolinium (contrast), pituitary protocol

Ependymoma vs MB: calcifications

Labwork

Pituitary adenoma-endocrine workup is preformed

Treatment

Surgical treatment options: primary goal of surgery is to remove as much of the tumor as possible without injuring important brain tissue.

  • Astrocytomas: most common intra-axial, glioma (cells that support/assist nerve cells) Glioblastoma multiforme: most common  1° malignant brain tumor in adults.  Principle treatment for surgical biopsy or partial resection, pilocystic astrocytoms, tumors causing obstruction of CSF or herniation.
  • Oligodendromas: presents with seizures. Gross total resection should be attempted if has large mass effect or low grade.
  • Meningomas: slow growing, usually benign arising from arachnoid. Most common benign brain tumor. Surgery is treatment of choice for symptomatic patients.
  • Pituitary adenomas: symptoms from abnormal pituitary labs or from mass effect (vision loss). Trans-sphenoidal approach preferred.
  • Ependymoma: arise from cells lining the ventricles and central canal of spinal cord, near the floor of the 4th ventricle causing hydrocephalus. Maximal resection followed by XRT, to prevent drop metastasis.
  • PNET:  MC is medulloblastoma, MC peds brain malignancy, roof of the 4th ventricle causing hydrocephalus. Surgical debulking followed by XRY.

Follow up

 Typically, patients who undergo a craniotomy for resection of a brain tumor spend around 3-5 nights in the hospital. The timing of post operative imaging or further treatment varies widely based on tumor type.