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.

Choroid plexus papillomas are only infrequently located in the third ventricle. Two infants with such lesions are presented and the diagnosis by computed tomography described. The transcallosal approach to the third ventricle was employed in both cases and led to successful excision. This approach is recommended for lesions in the anterior third ventricle in children, and the occurrence of subdural effusions as a complication is pointed out.

The authors review 60 children who presented with craniopharyngiomas. Patients were treated by either 1) cyst aspiration followed by deep x-ray therapy (DXT), 2) radical excision, 3) incomplete tumor excision, or 4) incomplete excision followed by DTX. Symptomatic clinical recurrence signified failure of treatment. Of the patients treated by cyst aspiration and DXT, 50% experienced recurrence (mean time after treatment, 4.4 years), while recurrences occurred in 23% undergoing radical excision (mean time, 2.4 years). Symptomatic recurrences occurred in 78% treated by incomplete removal only (mean time, 2.2 years). No recurrences have occurred in seven patients whose incomplete removal was followed by DTX. The authors conclude that radical excision is most likely to produce survival free of recurrence. When radical excision is not possible, DXT appears to provide an additional effect on preventing tumor regrowth. Characteristics of craniopharyngiomas favoring radical excision are also discussed.

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Table Lumbar puncture results: Day I Day 2 Day 18 Appearance turbid fluid slightly xanthochromic clear fluid Pressure cm 23 23 Protein g/l 3-4 4-8 9 Globulin mod increase mod increase mod increase Glucose mmol/l C.S.F. (serum) 45 (14-2) 3-5 (13-3) 2-8 (9-0) Chloride mmol/l 113