Pediatric intracranial tumor [Neurosurgery Wiki]

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====== Pediatric intracranial tumor ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/10QQLaXyfCAHaHEcNfI9AZ-9M4pxRenYBGX2rYD1HKeWUAD9x4/?limit=15&utm_campaign=pubmed-2&fc=20250302123816}}

The common [[pediatric brain tumor]]s (age < 20 years) are gliomas and [[glioneuronal tumor]]s (cerebellum,
brainstem, and optic nerve) (which account for 45% of primary CNS tumors in this age group),
[[embryonal tumor]]s (12.3%) (67% of which are [[medulloblastoma]]), pituitary tumors (6.2%), nerve
sheath tumors (4.2%), and [[craniopharyngioma]]s (3.8%).

Among patients < 20 years of age, the incidence of the following tumors decreases with age: pilocytic
astrocytoma, malignant glioma, ependymal tumors, choroid plexus tumors, and embryonal tumors.

===== Intracranial neoplasms during the first year of life =====

Brain tumors presenting during the first year of life are a different subset of tumors than those presenting later in childhood. In a busy neurosurgical unit in a children’s hospital, they represented ≈
8% of children admitted with brain tumors, an average of only ≈ 3 admissions per year.

90% of brain tumors in neonates are of neuroectodermal origin, teratoma being the most common. Some of these tumors may be congenital. Other supratentorial tumors include astrocytoma, choroid plexus tumors, ependymomas, and [[craniopharyngioma]]s. 

[[Posterior fossa tumor]]s include [[medulloblastoma]] and [[cerebellar astrocytoma]].

Many of these tumors escape diagnosis until they are very large in size due to the elasticity of the infant skull, the adaptability of the developing nervous system to compensate for deficits, and the difficulty in examining a patient with a limited neurologic repertoire and inability to verbalize or cooperate. The most common presenting manifestations are vomiting, arrest or regression of psychomotor development, macrocrania, and poor feeding/failure to thrive. They may also present with seizures.

===== Epidemiology =====

[[Pediatric Intracranial Tumor Epidemiology]].



===== Classification =====

[[Pediatric intracranial tumor classification]].





===== Diagnosis =====

Bächli et al., from the  [[Heidelberg]] University Hospital, [[Germany]], report a single-institutional collection of [[pediatric brain tumor]] cases that underwent a refinement or a change of [[diagnosis]] after completion of [[molecular diagnostics]] that affected clinical decision-making including the application of [[molecular]]ly informed targeted therapies. 13 pediatric [[central nervous system tumor]]s were analyzed by conventional histology, [[immunohistochemistry]], and molecular diagnostics including [[DNA methylation]] profiling in 12 cases, [[DNA sequencing]] in 8 cases and [[RNA sequencing]] in 3 cases. 3 [[tumor]]s had a refinement of diagnosis upon molecular testing, and 6 tumors underwent a change of diagnosis. [[Targeted therapy]] was initiated in 5 cases. An underlying [[cancer predisposition syndrome]] was detected in 5 cases. Although this case series, [[retrospective]] and not population based, has its limitations, insight can be gained regarding precision of diagnosis and clinical management of the patients in selected cases. Accuracy of diagnosis was improved in the cases presented here by the addition of molecular diagnostics, impacting clinical management of affected patients, both in the first-line as well as in the follow-up setting. This additional information may support the clinical decision making in the treatment of challenging pediatric CNS tumors. Prospective testing of the clinical value of molecular diagnostics is currently underway
((Bächli H, Ecker J, van Tilburg C, Sturm D, Selt F, Sahm F, Koelsche C, Grund
K, Sutter C, Pietsch T, Witt H, Herold-Mende C, von Deimling A, Jones D, Pfister 
S, Witt O, Milde T. Molecular Diagnostics in Pediatric Brain Tumors: Impact on
Diagnosis and Clinical Decision-Making - A Selected Case Series. Klin Padiatr.
2018 Jul 11. doi: 10.1055/a-0637-9653. [Epub ahead of print] PubMed PMID:
29996150.
)).

===== Treatment =====

[[Pediatric intracranial tumor treatment]].

===== Complications =====

see [[Pediatric intracranial tumor complications]].

===== Outcome =====

[[Pediatric intracranial tumor outcome]].

===== Case series =====

[[Pediatric intracranial tumor case series]].