Surgical Treatment of Brain Tumors in Infants Younger than Six Months of Age and Review of the Literature

Abstract

Object Brain tumors are rare in infants under 6-months of age. These tumors can be challenging to treat surgically. We analyzed a modern series of patients treated by a multidisciplinary team at a tertiary care center and performed a literature review of this unique population. Methods Retrospective clinical data was collected for patients surgically treated for intracranial mass lesions at The Children’s Hospital of Philadelphia from 1998 to 2007. Dermoid cysts and other skull-based lesions were excluded from the analysis. Results Sixteen patients under 6-months of age underwent surgery for primary intracranial mass lesions. The median age of the patients at surgery was 5.2 months (range 1.4 to 6 months of age). Children most often presented with a bulging fontanelle, hydrocephalus, or macrocephaly (7 patients). Vomiting was seen in 5 patients, cranial nerve palsies in 1 patient, and seizures in 3 patients. All patients had tumor resections and post-operatively were monitored in the intensive care unit. The final pathology consisted of atypical teratoid/rhabdoid tumor (3 cases), primitive neuroectodermal tumor/medulloblastoma (3 cases), choroid plexus papilloma (2 cases), astrocytoma (2 cases), ganglioglioma (2 cases), desmoplastic infantile ganglioglioma (2), glioblastoma multiforme (1), and choroid plexus carcinoma (1). Two intra-operative deaths occurred. Of the surviving 14, a gross total resection was achieved in 4. Adjuvant therapy was determined by a multidisciplinary team composed of neuro-oncology, neurosurgery, and radiation oncology. Seven patients were treated with chemotherapy, 1 patient had proton beam therapy. Five-year overall survival was 45%. The eight surviving patients had neurological sequelae, and developmental outcome was variable. Conclusions Brain tumors are uncommon in children under 6-months of age. Patients present with a variety of tumor pathologies. Children who survive have neurological sequelae. More studies are necessary to understand the impact that different treatment options, tumor pathology, and tumor location have on neurological outcome.

Neonatal Solid Tumors: Incidence and Survival in France

“…This could be due to the noninclusion of subjects with extracranial benign teratoma. A main problem of this tumor is the surgical aspect due to the importance of the tumor with probably a high mortality . We reported a poor survival for CNS tumors.…”

Desmoplastic infantile astrocytoma with multiple intracranial and intraspinal localizations at presentation

“…Brain MRI 1 month after surgery demonstrated rapid growth of the hypothalamic mass as well as of the pial [4]. It is difficult in infantile cerebral neoplasms to predict tumor histology and grading on the basis of the preoperative imaging, and surgical resection or biopsy to establish a diagnosis has been recommended [12,21]. Surgical resection has also been favored for treatment of DIA, and good quality of life can be achieved on long-term follow-up in patients with a single mass [7,21].…”

A rare case of congenital glioblastoma with atypical presentation in an eleven month-old infant: Case report with review of literature

“…[1] Brain tumors are quite uncommon in infants, especially below 6 months of age and when they occur have a dismal course. [2] The sites of occurrence, histopathology, and presentation differ considerably in infants when compared with other age groups. Teratomas are the most common congenital tumors with GBM accounting for 2-9%.…”

“…In a study by Lang et al ., surgical treatment outcomes were assessed in infants younger than 6 months with brain tumors and it was concluded that tumors of different histopathology had a variable but definite impact on the quality of life with residual neurological sequelae post surgery. [2]…”