White matter disease in children treated for malignant brain tumors

The objects of the study reported were to recognize different patterns of white matter disease (WMD) in the follow-up of children after surgery, radiation and/or chemotherapy for malignant primary brain tumors and to evaluate statistical data on the incidence of WMD and various risk factors.

Magnetic resonance imaging (MRI) records were evaluated retrospectively in the routine follow-up (range 6 months to 15 years after surgery) of 44 children with malignant primary brain tumors treated with surgery and radiotherapy and/or chemotherapy.

WMD was diagnosed in 28 children and subclassified into circumscribed white matter lesions (WML) and diffuse atrophy. WML were the most common finding ( n=13), followed by atrophy ( n=7) and the combination of both ( n=8). Statistical analysis revealed slightly more frequent atrophy in children younger than 5 years. WML could be linked with supratentorial location of the tumor, follow-up longer than 5 years, and the presence of a ventricular shunt. Intrathecal chemotherapy was also a factor, but because of the small sample size of the group this might not be valid. None of the children had neurological deficits attributed to these findings, but the impact on neuropsychological development was not determined.