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Intracranial tumors in first year of life: the CHEO experience
Naveen Mehrotra1, Mohammed F Shamji, Michael Vassilyadi
1Division of Neurosurgery, Children's Hospital of Eastern Ontario, 401, Smyth Road, Ottawa, Canada.
Insights
Pediatric brain tumors in infants are rare but require prompt diagnosis. Infratentorial lesions have a worse prognosis, but some infants achieve good functional outcomes with appropriate treatment.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Pediatrics
Background:
- Infant brain tumors constitute a significant portion of pediatric central nervous system neoplasms.
- Early diagnosis of these lesions is increasing due to advanced neuroimaging.
- Limited data exists on the natural history and long-term outcomes of brain tumors in the first year of life.
Purpose of the Study:
- To analyze the clinical characteristics, management, and outcomes of brain tumors diagnosed in infants.
- To investigate the impact of tumor location and histology on presentation and prognosis.
- To evaluate functional outcomes in surviving infants.
Main Methods:
- Retrospective chart review of pediatric brain tumor patients at Children's Hospital of Eastern Ontario (CHEO) over 34 years.
- Analysis of patients diagnosed within the first year of life, focusing on symptoms, management, and outcomes.
- Statistical analysis using ANOVA and chi-squared tests to compare patient groups.
Main Results:
- Eighteen infant brain tumors identified: 12 supratentorial (8 benign) and 6 infratentorial (all malignant).
- Posterior fossa tumors showed higher rates of increased intracranial pressure (p < 0.01).
- Gross total resection achieved in 47%; infratentorial lesions required more CSF diversion (p = 0.02) and adjuvant therapy (p < 0.01).
Conclusions:
- Infant brain tumors represent 4.8% of pediatric cases at CHEO.
- Tumor location and histology significantly influence presentation, treatment, and survival, with infratentorial lesions having a poorer prognosis.
- One-third of patients achieved acceptable functional outcomes without special assistance.
Introduction:
One seventh of pediatric brain tumors are diagnosed in the first year of life. With more widespread and accessible neuroimaging, these lesions are being diagnosed earlier, but there remains scant literature about their natural history.
Methods:
A retrospective review was performed of brain tumor patients presenting to the Children's Hospital of Eastern Ontario (CHEO) through the last 34 years. Patients presenting in the first year of life, including symptoms, management features, and functional outcome, were analyzed using ANOVA and chi (2) statistics.
Results:
Eighteen cases of brain tumors in the first year of life were identified: 12 suptratentorial, eight with benign histology, and six infratentorial all with malignant histology. Median age of presentation differed by lesion location (p = 0.05) and glial tumors were most common. Raised intracranial pressure was more than twice as prevalent with posterior fossa lesions (p < 0.01) with equivalent likelihood of increasing head circumference (p = 0.74), whereas seizures were more frequent with supratentorial tumors (p = 0.04). Gross total resection was achieved in 47% of patients, cerebrospinal fluid diversion was more frequently necessary among infratentorial lesions (p = 0.02), and adjuvant therapy was more utilized for infratentorial lesions (p < 0.01). Among eight surviving infants, seven had supratentorial tumors, five survived to adulthood, and six are functionally independent.
Conclusions:
Brain tumors in the first year of life represent 4.8% of patients treated at CHEO. Mode of presentation, utilization of adjuvant therapy, and survival depend on tumor location and histology, with worse prognosis for infratentorial lesions. One third of patients had acceptable functional outcome requiring no special assistance.
