Intracranial Neoplasms during the First Year of Life: Analysis of One Hundred Consecutive Cases

Jooma, Rashid; Hayward, Richard; Grant, D N

doi:10.1227/00006123-198401000-00008

Cited by 119 publications

(91 citation statements)

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“…As described by others [1, 3, 4, 7, 10, 13, 14, 15, 26, 32, 34, 35, 36], we also found a significantly higher incidence of supratentorial tumors in the group aged 1–12 months, with an inverse tendency in the second and third year of age. Furthermore, the majority (26/36) of the tumors originated from midline structures: fourth ventricle and cerebellar vermis and the suprasellar-chiasmatic-hypothalamic region were the commoner locations, respectively, below and above the tentorium.…”

Section: Discussionsupporting

confidence: 91%

“…In our series, surgical mortality was 10.2%; in other series [10, 12, 13, 15, 25, 32, 34, 35, 36, 38]it ranged from 33% to less than 5% in more recent years. On the question of morbidity, we noted new or worse neurological deficit in the postoperative period in 30% of the cases, but only 12% of these lasted more than 6 months; these incidences are similar to those described by others [8, 13].…”

Section: Discussioncontrasting

confidence: 47%

“…These patients are very vulnerable both intra- and postoperatively: incomplete brain myelinization in infants and physical restraints due to the smaller size of the undeveloped brain add difficulties to the surgical performance; rapid blood loss can be critical, leading to systemic hypotension and cardiac arrhythmias; electrolyte balance and body temperature need continuous monitoring [6]. For many years, the delay in diagnosis together with surgical and anesthesiological drawbacks have been related to high morbidity and mortality, especially for children in the first year of life and for those with tumors located in the posterior fossa [3, 7, 8, 9, 10, 11, 12]. Finally, as Cohen and Duffner pointed out, before new radiotherapy and chemotherapy strategies became available, parents were often inclined to withhold therapy entirely rather than commit the child to aggressive treatment where the likelihood of neurotoxicity sometimes overcame that of efficacy [2].…”

Section: Introductionmentioning

confidence: 99%

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Brain Tumors in Children Under 3 Years of Age

Sala¹,

Colarusso²,

Mazza³

et al. 1999

Pediatr Neurosurg

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Brain tumors in children under 3 years of age differ in clinical presentation and pathological behavior from those in older patients. In this study, we reviewed data from 39 children (24 males and 15 females) under 3 years of age who were treated for intracranial brain tumors since the introduction of magnetic resonance imaging. The purpose was to assess correlations between clinicoradiological and treatment-related factors, and their impact on prognosis. The following factors were analyzed: sex, age, duration of symptoms, intracranial hypertension on admission, tumor location, surgical removal and histology. Associations between these factors and correlations with prognosis were determined using bivariate analyses (² test) and Kaplan-Meier survival curves. Collins' concept of a period of risk recurrence was tested. Mean follow-up was 41 months (range 0-136). In March 1998, 20 children were still alive (51.2%) with a mean survival time of 65 months (range 2-136). The incidence of supratentorial tumors was significantly higher in children less than 1 year old (p = 0.027). Lateral tumors were 9/10 (90%) supratentorial versus only 7/26 (27%) midline tumors (p = 0.001). Outcome (dead or alive) was significantly better (p = 0.037) for low-grade astrocytomas (9/12 = 75% survival) when compared to ependymomas (2/6 = 33%) and primitive neuroectodermal tumors (3/12 = 25%). Total tumor removal was achieved in 20 cases and was associated with a better outcome (65 vs. 33% survival; p = 0.049). Survival analysis confirmed a worse prognosis for children with ependymomas and primitive neuroectodermal tumors (p = 0.011) and revealed a worse survival for children with intracranial hypertension on admission (p = 0.047). Total tumor removal was associated with a longer survival, although not significantly (p = 0.077). Finally, we found no exceptions to Collins' law.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

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Brain Tumors in Children Under 3 Years of Age

Sala¹,

Colarusso²,

Mazza³

et al. 1999

Pediatr Neurosurg

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“…The high incidence of total resection in the present series is due to the high proportion of choroid plexus tumors, where the tumors have a good plane and resection is possible after the vascular pedicle is visualized. Operative and perioperative mortality varied, ranging from no mortality as reported by Haddad et al [9] to 33% as reported by Jooma et al [10]. Tewari et al [11] reported a mortality of 57%, though this series included only supratentorial tumors.…”

Section: Discussionmentioning

confidence: 86%

Brain Tumors of Infancy - An Institutional Experience and Review of the Literature

2013

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Introduction: Brain tumors in infants are rare and form a distinct subgroup of pediatric brain tumors. These tumors differ from tumors in older children with respect to histology and management and tend to have a poorer outcome. Methods: We analyzed 31 consecutive cases of brain tumors in infancy managed in our institute in the last 15 years and reviewed the published literature since 1990. Results: Only 2 of these patients had congenital tumors. Choroid plexus tumors were the most common histological subtype, followed by medulloblastoma; 62% of patients underwent a gross total or near-total excision of the tumor with 1 perioperative mortality; 68% of patients had a good outcome. Conclusion: Choroid plexus tumors were the most common histological type. Safe resection should be the goal of surgery. Surgeries for tumors in this age group were associated with lower rates of total excision and higher morbidity. Low-grade lesions as expected are associated with longer survival; however, long-term outcomes are far from satisfactory.

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“…9,12,13,16,23 Their benign nature and intraventricular, noninfiltrative nature renders them surgically curable. 15,20,27 Gross-total resection has been associated with excellent prognosis, 9,18,20 with 5-year survival being close to 100% after complete resection, but survival is only 56% after subtotal resection.…”

Section: Discussionmentioning

confidence: 99%

Superior parietal lobule approach for choroid plexus papillomas without preoperative embolization in very young children

Kennedy¹,

Cloney²,

Anderson

et al. 2015

PED

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OBJECT Choroid plexus papillomas (CPPs) are rare neoplasms, often found in the atrium of the lateral ventricle of infants, and cause overproduction hydrocephalus. The extensive vascularity and medially located blood supply of these tumors, coupled with the young age of the patients, can make prevention of blood loss challenging. Preoperative embolization has been advocated to reduce blood loss and prevent the need for transfusion, but this mandates radiation exposure and the additional risks of vessel injury and stroke. For these reasons, the authors present their experience using the superior parietal lobule approach to CPPs of the atrium without adjunct therapy. METHODS A retrospective review was conducted of all children who presented to Columbia University/Morgan Stanley Children's Hospital of New York with a CPP in the atrium of the lateral ventricle and who underwent surgery using a superior parietal lobule approach without preoperative embolization. RESULTS Nine children were included, with a median age of 7 months. There were no perioperative complications or new neurological deficits. All patients had intraoperative blood loss of less than 100 ml, with a mean minimum hematocrit of 26.9% (range 19.6%–36.2%). No patients required a blood transfusion. The median follow-up was 39 months, during which time no patient demonstrated residual or recurrent tumor on MRI, nor did any have an increase in ventricular size or require CSF diversion. CONCLUSIONS The superior parietal lobule approach is safe and effective for very young children with CPPs in the atrium of the lateral ventricle. The results suggest that preoperative embolization is not essential to avoid transfusion or achieve overall good outcomes in these patients. This management strategy avoids radiation exposure and the additional risks associated with embolization.

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Intracranial Neoplasms during the First Year of Life: Analysis of One Hundred Consecutive Cases

Cited by 119 publications

References 0 publications

Brain Tumors in Children Under 3 Years of Age

Brain Tumors in Children Under 3 Years of Age

Brain Tumors of Infancy - An Institutional Experience and Review of the Literature

Superior parietal lobule approach for choroid plexus papillomas without preoperative embolization in very young children

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