The Massachusetts General Hospital Handbook of Neurology

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Child Neurology > Tumors

Tumors

A. See also adult sections

Tumors of Brain, p. 120, and Spinal Cord Disorders, p. 113.

B. XRT in children

Causes IQ loss and is usually avoided in pts <3 yrs.

C. Infratentorial tumors

The most common pediatric location.

• H&P: Ataxia, signs of high ICP or hydrocephalus, corticospinal and cranial nerve signs, head tilt.

• Brainstem gliomas: Malignant. Usually no hydrocephalus until late. Peak incidence age 2-12 yr. Rx: XRT, dexamethasone.

• Cerebellar astrocytoma: Benign, usually cystic. Rx: Surgery, usually do not need XRT.

• Ependymoma: Malignant, often on floor of 4th ventricle. Peak incidence 0-4 yr. Early vomiting. Can seed spinal cord. Rx: surgery; high-grade tumors need XRT of head and spine.

• Medulloblastoma: Malignant, often in vermis, neuronal origin. Peak incidence age 3-6 yr. Can seed spinal cord. Rx: surgery, head and spine XRT, chemotherapy.

D. Supratentorial tumors

Seizures and hemiparesis are common (vs. infratentorial tumors).

P.152

• Craniopharyngiomas: Suprasellar tumor, presents with signs of high ICP, pituitary dysfunction, or visual field deficits. Rx: surgery and XRT; prognosis relatively good.

• Gliomas: Rx of cerebral gliomas depends on the grade of the tumor. Rarely, children age 0-4 yr present with weight loss despite a voracious appetite caused by a hypothalamic glioma.

• Optic gliomas present with poor vision, strabismus, exophthalmos, optic atrophy, or papilledema. Surgery vs. XRT is controversial; rx is sometimes conservative. Often associated with neurofibromatosis.

• Primitive neuroectodermal tumors (PNETs): Pathology similar to medulloblastoma. Often presents in pts <3 yr. Rx: XRT of head and spine chemotherapy.

E. Intracranial metastases

Rare in children, except from leukemia or lymphoma.

• Leukemic infiltration of the meninges: Pts present with headache, papilledema, diplopia. To prevent this, methotrexate and XRT of head and spine are usually given during hematological remission; this can cause an encephalopathy.

• Intracranial hemorrhage: From low platelets; not seen in lymphoma.

• CNS infection: If peripheral white counts are low, CSF may not show lymphocytosis.