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Primary intracranial neoplasms in the first year of life
A Asai1, H J Hoffman, E B Hendrick
1Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study analyzed 41 infants with brain tumors, finding astrocytomas most common. Many infants required shunts and radiotherapy, with a 7.3% surgical mortality rate and 39% overall mortality within six months.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Pediatric Neurosurgery
Background:
- Primary intracranial neoplasms in infants are rare but serious conditions.
- Early diagnosis and treatment are crucial for outcomes in pediatric brain tumors.
Purpose of the Study:
- To describe the clinical characteristics, treatment, and outcomes of primary intracranial neoplasms in infants.
- To analyze survival rates based on tumor histology and treatment modalities.
Main Methods:
- Retrospective analysis of 41 infants diagnosed and treated for primary intracranial neoplasms within the first year of life.
- Review of tumor histology, location, presenting features, surgical resection, CSF diversion, and radiotherapy.
- Assessment of surgical mortality and overall survival rates.
Main Results:
- Astrocytomas (41%), primitive neuroectodermal tumors (22%), and choroid plexus papillomas (20%) were the most common types.
- Vomiting and increasing head size were the most frequent presenting symptoms, often with short duration (≤2 months in 87%).
- Surgical mortality was 7.3%, with 39% of patients dying within six months of diagnosis; survival varied by histologic type.
Conclusions:
- Infant brain tumors present unique challenges requiring multidisciplinary management.
- Timely surgical intervention and adjuvant therapies are critical, though outcomes remain guarded for many histologic subtypes.
- Further research into novel therapeutic strategies is warranted to improve survival and neurodevelopmental outcomes.
Abstract:
Forty-one infants with histologically verified primary intracranial neoplasms were studied who had been diagnosed and treated during the first year of life at the Hospital for Sick Children during the years 1975-1986. Forty-one percent of tumors were astrocytomas, 22% were primitive neuroectodermal tumors, and 20% were choroid plexus papillomas. Seventy-one percent were located in the supratentorial compartment and 29% in the infratentorial compartment. Thirty percent were in the cerebral hemisphere, 12% in the optic pathway-hypothalamic region, 5% in the thalamus, 17% in the cerebellum, 5% in the brain stem, 12% in the lateral ventricles, 12% in the III ventricle, and 7% in the IV ventricle. The most common presenting features in this series of patients were vomiting and increasing head size. The symptoms and signs before diagnosis were present for 2 months or less in 87% of cases. Forty-four percent of the tumors were totally resected while only a partial resection or biopsy was carried out in 56%. Sixty-six percent of the patients required a CSF diversionary shunt. Twenty-nine percent of patients received radiotherapy. Slightly more than half of these received radiotherapy immediately after surgery, whereas delayed radiation therapy was performed in the remainder. The surgical mortality was 7.3%. Of the entire group, 39% have died, with most dying within 6 months of surgery. Treatment, survival relative to histologic type, psychomotor development, and neurologic function of the survivors are discussed.