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Intracranial neoplasms during the first year of life: analysis of one hundred consecutive cases
Insights
Infants with brain tumors often present with vomiting and developmental changes. Surgical intervention and modern treatments significantly improve survival rates for these pediatric neoplasms.
Area of Science:
- Pediatric neuro-oncology
- Infant neurosurgery
Background:
- Intracranial tumors in infants (first year of life) present unique challenges.
- Understanding the epidemiology and clinical features of these rare pediatric neoplasms is crucial.
Observation:
- Supratentorial tumors of neuroectodermal origin were more common in infants compared to older children.
- Presenting symptoms included vomiting, psychomotor development alterations, and macrocrania.
- Computed tomography (CT) and skull radiography are key diagnostic tools, with 92% showing abnormalities.
Findings:
- Medulloblastomas (20%), choroid plexus papillomas (12.5%), and cerebellar astrocytomas (10%) were the most frequent verified neoplasms.
- Average survival was 27 months, increasing to 37 months with surgical intervention.
- Operative mortality was 30%, with 43% 5-year survival in irradiated patients.
- High morbidity (60% disabled) was observed, with potential long-term deficits from high-dose radiation.
Implications:
- Improved mortality and morbidity rates were noted for patients treated after 1970, suggesting advances in care.
- Early diagnosis and tailored treatment strategies are essential for improving outcomes in infant brain tumors.
- Long-term neurodevelopmental follow-up is critical for survivors due to high rates of disability.
Abstract:
One hundred infants with intracranial tumors symptomatic during the 1st year of life were studied. They differed from older children in having a higher percentage of supratentorial tumors and in the fact that 90% of the tumors were of neuroectodermal origin. Vomiting, alteration of psychomotor development, and macrocrania were the most common presenting features. The "diencephalic syndrome" was seen in 5 infants, and subarachnoid hemorrhage due to tumor was diagnosed in 4. Computed tomography as the primary investigation is increasing the number of neoplasms diagnosed in this age group, although review of the skull roentgenograms in the series disclosed an abnormality in 92%. Eighty of the tumors were verified, 68 by a cranial operation and the rest at autopsy. Of the verified neoplasms, 20% were medulloblastomas, 12.5% were choroid plexus papillomas, and 10% were cerebellar astrocytomas. The cumulative average survival was 27 months but, for those who underwent a tumor operation, the average survival was 37 months. The operative mortality was 30%. Thirty-nine patients were irradiated, and this subset had a 5-year survival rate of 43%. The morbidity was high irrespective of radiotherapy; 60% of those who survived 1 year were moderately or severely disabled. Those infants receiving more than 5000 rads of whole brain radiation tended to have greater deficits in the long term. When analyzed separately, patients treated after 1970 had greatly improved mortality and morbidity rates.