Intracranial tumors in first year of life: the CHEO experience

Abstract

Brain tumors in the first year of life represent 4.8% of patients treated at CHEO. Mode of presentation, utilization of adjuvant therapy, and survival depend on tumor location and histology, with worse prognosis for infratentorial lesions. One third of patients had acceptable functional outcome requiring no special assistance.

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…Interestingly, all 20 patients lived beyond four years, and 17 remained alive at eight years of follow-up [35]. These two studies that imply both the effectiveness and safety of aggressive brain tumour resection in infants is counter to another study on 18 infants under one year of age who had a variety of grade I through IV lesions [170]. In this series, there was only one peri-operative death, due to massive brain haemorrhage in an 8-month old child with a deep, right parieto-occipital ganglioglioma.…”

“…Although in some small series of patients, seizures have been found to occur in up to 50% of paediatric patients with a brain tumour [170], in most populations, the overall incidence of seizures in this patient population is considerably lower, in the 10-20% range [51,89,90]. This is largely due to the infratentorial location of the majority of paediatric tumours, where very few are epileptogenic [37].…”

“…That such risks exist is certainly true of radiation therapy [18,20,64,[153][154][155][156], but it also is true of surgery [170]. However, recent studies have shown that surgery to resect epileptogenic brain tumours is both effective and safe for the vast majority of infants and toddlers [35,55,171].…”

“…Of the nine patients who had preoperative seizures, three improved, five did not improve, and one died. Overall, as of the paper's publication, only eight of the twenty patients had survived beyond infancy, with five now into adulthood (ages 18 -26) [170]; two of the adult survivors were severely disabled at the time of the report, both having a Karnofsky score [224] of just 40%. Also worth noting from Table 2 are the six studies in which only patients with dysembryoplastic neuroepithelial tumours (DNETs) were included (Table 3) [61,62,94,132,182,184].…”

“…Additional patients were noted to suffer from the post-operative onset of new seizures [170]. And still others had complete control of their seizures, only to relapse later, either while still on an anti-epileptic drug or after all AEDs had been withdrawn.…”