Brain tumors are the most common solid tumors in childhood.
It is second only to hematologic diseases in the incidence of pediatric malignant diseases. It can develop in every age group. Its high incidence age is 5-8 years. The predominant site of intracranial tumors in pediatric patients is the midline, often in combination with hydrocephalus. Common tumors include cerebellar astrocytoma, medulloblastoma, ventricular meningioma, brainstem glioma, germ cell tumor, and choroidal papilloma.
Clinical presentation characteristics of pediatric brain tumors.
Pediatric brain tumors have their own and organism physiological characteristics, so there are also unique features in the treatment of pediatric brain tumors. The onset of pediatric brain tumor is insidious, and most of the clinical manifestations are non-specific, and the tumor is often large when diagnosed. However, because children have stronger recovery ability than adults, not all of them are incurable. At this time, it is important to remember to rush to the doctor, and in order to achieve good results, comprehensive and active treatment is important.
Intracranial hypertension symptoms.
Children of older age groups may have complaints of headache. Vomiting is the early and often the only symptom in younger children. Some children still have a good appetite and can still eat after vomiting, and only later do they show increased vomiting, decreased eating and weight loss. Infants do not report headaches, but mainly show a full fontanelle and increased head circumference. Increased cranial pressure may also lead to secondary optic nerve atrophy and vision loss.
Focal symptoms of tumor.
1.Limb paralysis is common in cerebral hemisphere tumor.
Seizures: Seizures are seen in cerebral hemisphere tumors, and are mostly slow-growing low-grade malignant tumors, with focal or generalized seizures.
3. Ataxia: gait staggering, often accompanied by nystagmus, mostly seen in cerebellar tumors.
4.Vision loss and visual field defects: cranial pressed canal tumor and other tumors in the pterygoid saddle area compress the optic cross unfortunately optic nerve atrophy and visual field defects.
5. Hypothalamic and pituitary dysfunction: Tumors in the saddle area or anterior horn of the third ventricle and germ cell tumors in other parts of the brain can cause symptoms such as dwarfism, precocious puberty, uveitis or obesity.
Examination of pediatric brain tumors.
Cranial imaging is the key to further confirm the diagnosis. CT can help most children with obvious diagnosis, but is not as clear as magnetic resonance imaging (MRI) for tumors in the posterior cranial fossa region due to interference by overlapping bone shadows at the skull base. Other common tests include methemoglobin, carcinoembryonic antigen, and chorionic gonadotropin test for germ cell tumors.
Treatment of pediatric brain tumors.
Each tumor is treated differently. For example, total surgical excision of cerebellar hairy cell astrocytoma in children and choroidal from papilloma in young children can achieve cure; while surgery is not the first choice for germ cell tumor alone, radiotherapy can sometimes achieve cure. Treatment of ventricular meningioma should be primarily surgical, and radiotherapy has a more limited role, even though local radiotherapy is usually recommended; medulloblastoma requires total surgical excision if possible, and postoperative radiotherapy is also combined with radiotherapy. The treatment of craniopharyngioma is controversial, with some scholars advocating total surgical excision, some advocating postoperative combination with radiotherapy, and some foreign scholars advocating major resection (they believe that quality of life is more important and that recurrence means reoperation).
The principles of surgical treatment treatment include.
1.Total resection of the tumor as far as possible
2. For those who cannot be completely resected, the tumor should be removed as much as possible to relieve the pressure on important intracranial structures, including restoring normal cerebral crest fluid circulation to relieve intracranial hypertension, etc., and to create conditions for radiotherapy and chemotherapy later.
3. To make pathological diagnosis of the resected tumor.
Principles of radiotherapy.
It is a common adjuvant therapy after surgery, mainly used for those who cannot be completely resected by surgery or recurrence after surgery. Radiotherapy should be avoided as much as possible in children under three years of age. For germ cell tumors, radiotherapy is the main treatment, combined with chemotherapy can reduce the recurrence rate and control the dose of radiotherapy. Non-germ cell tumor germ cell tumor less than 3.5cm in diameter can be operated directly and radiotherapy can be selected according to pathology after surgery; diameter greater than 3.5cm can be treated with chemotherapy first on a trial basis, if it shrinks, surgery becomes easier and radiotherapy can be selected according to pathology after surgery, if it does not shrink, surgery can only be reluctantly performed.
Chemotherapy: In principle, it is used for postoperative treatment of malignant tumors in synergy with radiotherapy, and also for the treatment of those with recurrence of malignant tumors. For children with medulloblastoma and germ cell tumors adjuvant chemotherapy can reduce the rate of tumor recurrence and help control the dose of radiotherapy.
For huge medulloblastoma and non-germ cell tumor germ cell tumor, 1-2 courses of chemotherapy can be considered before surgery, followed by surgical resection after tumor shrinkage, and radiotherapy after surgery. We call this approach “sandwich” therapy.
Immunotherapy: It may have a good prospect, but unfortunately, it is still in the research stage.