Brain Tumors in Children Under 3 Years of Age

Abstract

Brain tumors in children under 3 years of age differ in clinical presentation and pathological behavior from those in older patients. In this study, we reviewed data from 39 children (24 males and 15 females) under 3 years of age who were treated for intracranial brain tumors since the introduction of magnetic resonance imaging. The purpose was to assess correlations between clinicoradiological and treatment-related factors, and their impact on prognosis. The following factors were analyzed: sex, age, duration of symptoms, intracranial hypertension on admission, tumor location, surgical removal and histology. Associations between these factors and correlations with prognosis were determined using bivariate analyses (<chi>² test) and Kaplan-Meier survival curves. Collins' concept of a period of risk recurrence was tested. Mean follow-up was 41 months (range 0-136). In March 1998, 20 children were still alive (51.2%) with a mean survival time of 65 months (range 2-136). The incidence of supratentorial tumors was significantly higher in children less than 1 year old (p = 0.027). Lateral tumors were 9/10 (90%) supratentorial versus only 7/26 (27%) midline tumors (p = 0.001). Outcome (dead or alive) was significantly better (p = 0.037) for low-grade astrocytomas (9/12 = 75% survival) when compared to ependymomas (2/6 = 33%) and primitive neuroectodermal tumors (3/12 = 25%). Total tumor removal was achieved in 20 cases and was associated with a better outcome (65 vs. 33% survival; p = 0.049). Survival analysis confirmed a worse prognosis for children with ependymomas and primitive neuroectodermal tumors (p = 0.011) and revealed a worse survival for children with intracranial hypertension on admission (p = 0.047). Total tumor removal was associated with a longer survival, although not significantly (p = 0.077). Finally, we found no exceptions to Collins' law.

Congenital Tumors of the Central Nervous System: The MCH Experience

“…From that work, the prognostic features that bore out in significance were the malignant nature of the lesion and the extent of surgical resection. Common themes among the reported series include the higher frequency of supratentorial tumor localization, more aggressive tumor histology, and greater difficulty achieving a total resection [2,9,10,11,12,15,17]. A cooperative study by the International Society of Pediatric Neurosurgery [8] confirms the more frequent supratentorial tumor location, although 41% of 886 patients presented with intracranial hypertension and only 12% with seizures.…”

“…Similarly, quality-of-life (QoL) measures have only recently been appearing in the literature, but suggest that good long-term functional outcome may be achievable [6,7], although patients often experience long-term seizure activity [8]. These findings may result from tumor location more frequently being supratentorial with lesions that are larger at presentation, more aggressive in behavior, and more difficult to resect owing to smaller anatomic structures and more complex perioperative management [9,10,11,12]. …”

Epidemiology of brain tumors in children aged two and under: A 10-year single-institute study

“…The clinical manifestations, location and histological features of brain tumors in infants and young children less than two years old reportedly differ by age (6). Supratentorial tumors occur more frequently than infratentorial tumors in the youngest patients.…”

Intracranial Fibrosarcoma Arising 5 Years after Chemotherapy Alone for Glioblastoma multiforme in a Child

“…No children under the age of 15 months were reported [1]. In a series of 39 children diagnosed with brain tumors under the age of 3 years in Verona, Italy, only 1 had glioblastoma multiforme [10]. From a literature review, it appears that children either have congenital glioblastoma multiforme and presented within the first couple months of life or developed the tumor after the first several years of life [1, 5, 9].…”