Article
Diagnosis, treatment and prognosis of brain tumors in infancy – a single center study
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Authors
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Sevgi Sarikaya-Seiwert
- Neurochirurgische Klinik , Heinrich-Heine-Universität , Düsseldorf , Deutschland
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Thomas Beez
- Düsseldorf , Deutschland
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Janina Klasen-Sansone
- Düsseldorf , Deutschland
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Hans-Jakob Steiger
- Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
| Published: | June 9, 2017 |
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Outline
Text
Objective: 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. Malignant histology is common, with persistently poor outcomes evolving adjuvant therapy.
Methods: We reviewed retrospectively the charts and the images of all patients under the age of 12 months who underwent brain tumor surgery from 2006 to 2016 treated in our institute. The charts were analyzed according to the age of the onset of symptoms, location of tumors, surgical treatment, histological results and outcomes. Data of outcome were analyzed using Kaplan–Meier plots, chi-square test.
Results: 37 patients were included in the study (13 girls and 24 boys). Four cases were diagnosed in the last three weeks during pregnancy, 18 cases within 6 months and the remaining 15 patients up to the end of 1 year of age. In 29 cases the tumor were localized supratentorial and in 8 cases infratentorial. Low and high grade glial cell tumors (18) and embryonal tumors (12) were the most common histological subtype, followed by ependymomas (5) and choroid plexus tumors (2); 76% of patients underwent a gross total or near total excision of the tumor with one perioperative mortality; Increasing head size due to raised ICP was the most common presenting feature in more than 77% of infants followed by seizures. 81% of the patients developed persistent multifocal CSF diversion problems with the need of ventriculo-cysto-peritoneal shunt placement. The range of follow-up was 2–129 months with a median follow-up of 41 months. The overall survival was 78.4%.
Conclusion: Low and high grade glial cell tumors and embryonal tumors were the most common histological subtype. Surgeries for tumors in this age group were associated with lower rates of total excision and higher morbidity due to complex CSF diversion problems. Safe resection should be the goal of surgery. Low-grade lesions as expected are associated with longer survival; however, long-term outcomes are far from satisfactory.
