[Brain tumors in infants]

In 76 of 575 children operated on for intracranial tumors during a 15 year period, symptoms had started during the first 2 years of life. Excision of the tumor was complete in 44, subtotal in 13, partial in 13, and in 6 only a biopsy was taken. Surgical mortality was 13% (10/76). 31 died later as their tumors progressed. The overall survival rate was 46% and 27 of the survivors are leading useful lives, with no signs of recurrence, 8 months to 14 years after operation. All of these had total or subtotal removal of the tumor. Only 3 required oncologic treatment. Despite radical surgery, the late neuropsychological results were good. However, 8 children who had had brain irradiation are severely handicapped. We conclude that in infancy functional recovery from a focal surgical lesion, even if extensive, is more complete than after diffuse damage to the immature central nervous system caused by irradiation. In this age group brain irradiation leads to severe handicapping in the great majority of cases. Radiotherapy should therefore be used only for highly malignant tumors, especially when surgical excision is incomplete. Radical surgery gives the best results in terms of survival and satisfactory neuropsychological state.