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Supratentorial tumours in infants
M K Tewari1, B S Sharma, R K Mahajan
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Supratentorial brain tumors in infants are rare but aggressive, with high mortality. Early diagnosis and improved treatments are crucial for better outcomes in these young patients.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Neuro-oncology
Background:
- Supratentorial brain tumors in infants (under 1 year) are uncommon, representing a small fraction of pediatric brain tumors.
- These tumors present unique diagnostic and therapeutic challenges due to the patient's age and tumor characteristics.
Purpose of the Study:
- To analyze the clinical presentation, histological types, and treatment outcomes of infants with supratentorial brain tumors.
- To identify factors contributing to the high morbidity and mortality in this patient group.
Main Methods:
- Retrospective review of 14 infants (below 1 year) with supratentorial brain tumors treated over 4 years.
- Data collected included clinical features, tumor histology, management strategies, and survival rates.
Main Results:
- Common symptoms included increased head size, vomiting, and failure to thrive. Tumors were often large and histologically malignant.
- Perioperative mortality was high at 57%, with only 30% surviving beyond 1 year.
- Factors like delayed diagnosis, poor pre-operative condition, and tumor aggressiveness contributed to poor outcomes.
Conclusions:
- Infantile supratentorial brain tumors are associated with dismal prognoses due to their aggressive nature and diagnostic delays.
- Urgent diagnosis and multimodal treatment approaches are essential to improve survival rates in this vulnerable population.
Abstract:
Three hundred and ninety-six paediatric (below 15 years of age) patients with brain tumours were treated at our institute in the last 4 years. Eighty-two of the tumours were located supratentorially. These 82 patients included 14 infants (below 1 year of age), who made up 3.5% of all paediatric patients with brain tumours and 17% and those with brain tumours in a supratentorial location. There was a male preponderance, and two-thirds of the 14 patients were within their first 6 months of life. Increasing head size, vomiting and failure to thrive were the common presenting features. One infant presented with asymmetric skull growth. The tumours tended to be large, occupying almost the entire affected cerebral hemisphere; histological types included astrocytomas, malignant astrocytomas, glioblastoma multiforme, primitive neuroectodermal tumours, malignant choroid plexus papillomas and malignant teratomas. Two children had congenital tumours and another two tumours, in children with associated lobar agenesis, were thought to be congenital in origin. Associated hydrocephalus was present in seven patients, but precraniotomy shunt was required in only two patients. The perioperative (within 1 month) mortality was 57%. Only 30% of the patients survived for more than 1 year after surgery and chemotherapy. The longest survival was 20 months. Delay in diagnosis, poor general condition prior to surgery, and the high vascularity and malignant nature of these tumours accounted for the poor results.