Pediatric Brain Tumors

Michael Fisher, M.D., P.D., P.H.O.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

The Planners of this activity have no relationships to disclose.

Michael J. Fisher, MD, is assistant professor of pediatrics at the University of Pennsylvania School of Medicine, and a neuro-oncologist in the Division of Oncology, Children's Hospital of Philadelphia. Here, he discusses the epidemiology, etiology, pathogenesis, clinical presentation, diagnosis and treatment for several types of pediatric brain tumors.

This lecture and the post-test is worth 1.5 credit hours.

Medulloblastoma is the commonest malignant pediatric brain tumor and astrocytoma the commonest benign tumor, says Dr. Fisher, who points out that while central nervous system tumors are the second commonest pediatric tumor, they are the principal contributor to pediatric cancer mortality. Predisposing factors include inherited familial syndromes, immunodeficiencies and exposure to ionizing radiation.

Symptoms of pediatric brain tumors depend upon location: cranial nerve deficits and long tract signs such as hemiparesis, spasticity, and Babinski's sign are characteristic of brain stem tumors, for example. The author describes MRI as the standard diagnostic tool, while positron emission tomography (PET) can distinguish between benign and malignant lesions. Treatment options include surgical resection, radiotherapy, and chemotherapy in pediatric brain tumors. In a discussion of late effects of treatment, the author stresses that survivors should be followed up at regular intervals.

The epidemiology, MRI appearance, prognostic factors, therapy, and survival rates for medulloblastoma, or primitive neuroectodermal tumors are covered, with standard risk medulloblastoma having a 3-year progression-free survival rate of 86%. Ependymona and the types of gliomas – optic pathway, hypothalamic, brain stem, and supratentorial gliomas – are described along with their treatment and prognostic factors.

The lecture concludes with a discussion of dorsally exophytic tumors in childhood and focal midbrain tumors as well as cervicomedullary tumors and germ cell tumors and the benign craniopharyngiomas.