Brain and Spinal Cord Tumors in Children:

Brain and spinal cord tumors are the third most common type of childhood cancer, after leukemia and lymphoma.



These tumours can occur anywhere in the different parts of the brain and spinal cord. In children, most common locations are in the lower part of the brain, such as cerebellum and brainstem.

Common Tumours in Children

1. Astrocytoma
2. Ependymoma
3. Medulloblastoma
4. Brainstem Glioma
5. Craniopharyngioma
6. Pineal gland tumours
7. Intramedullary spinal cord glioma

Symptoms

The symptoms of childhood brain and spinal cord tumors are not the same as in adults or in every child.

Brain Tumor Symptoms
  • Morning headache or headache that goes away after vomiting
  • Frequent nausea and vomiting
  • Vision, hearing, and speech problems
  • Double vision, limb weakness, swallowing difficulties (typical of brainstem glioma)
  • Loss of balance and trouble walking
  • Unusual sleepiness or change in activity level
  • Unusual changes in personality or behavior
  • Seizures
  • Increase in the head size (in infants)
  • Delayed growth and developmental milestones, for example poor speech or walking ability


MRI scan of a Supratentorial Ependymoma.

Treatment

Treatment considerations for children are somewhat different from adults. Long-term side effects are an important issue. The treatment options also depend on the type of tumor and where the location.

Surgery, radiotherapy and chemotherapy are considered in each case, just as in adults. In certain cases, image-guidance systems (IGS) and intra-operative nerve monitoring are used to improve surgical results and outcome. Sometimes immunotherapy (anti-EGFR and anti-VEGF) is also given to reduce tumour progression



MRI scan showing a large germ cell tumour in the pineal gland.



Post-operative CT scan showing a complete tumour resection (Histology was ‘mature teratoma’).



MRI scan showing a large diffuse brainstem (pontine) glioma. In such cases, surgery is not advised and the treatment is usually radiation therapy, followed by immunotherapy.



MRI showing a more focal brainstem tumour. In such cases, surgery can be done to biopsy and/or debulk the tumour, depending on the exact location within the brainstem. These lesions tend to be benign or low-grade astrocytomas.



Picture showing the IGS and Intra-operative nerve monitoring set-up for brainstem surgery in a child with focal brainstem tumour.



MRI scan showing a dorsal cervicomedullary brainstem tumour.



Picture showing operative approach to dorsally exophytic tumours of the brain stem and posterior fossa,

Intramedullary Spinal Cord Tumours

These commonly occur in children and teenagers. Most of these tumours are low-grade and slow-growing. The most common tumours are astrocytoma, ganglioglioma and ependymoma.

The best treatment is surgery to remove the tumour.



MRI scan showing a intramedullary spinal cord tumour (arrowed) in the cervical spine, with the typical syrinx at the rostral and caudal aspects of the tumour. The scan image on the right shows the spinal cord after the tumour has been surgically resected.

Stroke Hydrocephalus Brain Tumour Arachnoid Cyst Spine Conditions (Adults) Spine Conditions (Children) Brain and Spinal Cord Tumors in Children




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