Brain tumours
Key points
Most common solid childhood cancer
Classified into supratentorial and infratentorial tumours, or by age: congenital brain tumours (CBT), infancy tumours (under 1 year), older children
Supratentorial tumours common in children under 3 years
Posterior fossa tumours common between ages 4 to 10
CBTs diagnosed antenatally or within the first 2 months of life
Prognosis depends on age at presentation, histological type, and extent of resection
Common Types of Congenital Brain Tumours
Teratoma
Choroid plexus papilloma
Desmoplastic infantile tumours (DIA/DIG)
Glioblastoma multiforme (GBM)
Medulloblastoma
Aetiology
No direct cause identified; genetic and environmental factors involved
Cancer predisposition syndromes (e.g., DICER1, Li-Fraumeni, neurofibromatosis) linked to brain tumours
Family history and parental age at birth may influence risk
High-dose radiation linked to brain malignancies
Typically most don't metastasise
Medulloblastomas can, vascular spread
Histology
Teratomas - mature, immature, or malignant
Gliomas: arise from glial cells, classified by WHO grades I-IV
Medulloblastoma: consists of four subgroups (WNT, SHH, group 3, group 4)
Differential Diagnosis
Abscess, congenital CNS infections, intracranial haemorrhage, ischaemic stroke, neurocutaneous syndromes
Paediatric Surgery involvement
Insertion of Hickman lines for chemotherapy and proton beam therapy
Treatment induced vomiting - may require PEG
Prognosis
Poor prognosis for congenital brain tumours, overall survival less than 30%
Survival influenced by malignant histology, tumour size, location, stage of fetal development, treatment complications
References
Subramanian S, Ahmad T. Childhood Brain Tumors. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535415/