Initial Management of Childhood Brain Tumors: Neurosurgical Considerations

Abstract

Intracranial tumors are the most common solid tumors in children. The infratentorial compartment will be the primary site for 60% to 70% of these tumors, including astrocytomas, medulloblastomas, and ependymomas. Several technological advancements have increased our knowledge of the cell biology of pediatric brain tumors, facilitated earlier diagnosis, and improved neurosurgical resections while minimizing neurological deficits. These in turn have not only improved the survival of children with brain tumors but also their quality of life. Current management strategies in most cases rely on surgery coupled with adjuvant therapies, including radiation therapy and chemotherapy. The vulnerability of the immature brain to adjuvant therapies creates many challenges for the treating physician. We review current diagnostic and therapeutic approaches and outcome for children harboring the most common pediatric brain tumors: astrocytomas (low- and high-grade glioma), ependymoma, medulloblastoma, and craniopharyngioma. The emphasis will be on the neurosurgical management of children with these tumors.

Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas

“…3,4,20,23,25,33 Because cytoreduction plays such a pivotal role, ependymoma is a "surgical disease" by nature. As such, subtotally resected and high-grade cases typically receive adjuvant treatments, such as radiation and chemotherapy.…”

Child-related characteristics predicting subsequent health-related quality of life in 8- to 14-year-old children with and without cerebellar tumors: a prospective longitudinal study

“…Their greater increase in these deficits between preoperative and postoperative assessments may be attributable to their more midline location, less well-defined margins, and more vigorous neurosurgical effort to improve survival rates by achieving complete resection. 45 Current guidelines in the UK suggest that psychological assessment of childhood brain tumor survivors should be undertaken only when concerns about poor HRQoL are raised by teachers or parents, 6 and this problem is not confined to the UK. 46 Identification of difficulties is therefore frequently late, but more timely interventions could be informed by early screening.…”

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

“…However, since these patients have a high overall survival rate, the cost of total resection must not include an increased risk of iatrogenic neurological deficits. 8,10 One of the most important neurosurgical tools in achieving the goal of safe, complete resection (CR) of an intraaxial lesions is, together with intraoperative electrophysiological monitoring (IOM), surgical guidance via intraoperative MRI (iMRI), which has become more widely AbbreviAtioNs CR = complete resection; DNET = dysembryoplastic neuroepithelial tumor; EOR = extent of resection; ICU = intensive care unit; iMRI = intraoperative MRI; IOM = intraoperative electrophysiological monitoring; IR = incomplete resection; LGG = low-grade glioma; PFS = progression-free survival; PR = partial (or subtotal) resection. objeCtive Intraoperative MRI (iMRI) is assumed to safely improve the extent of resection (EOR) in patients with gliomas.…”