MDNews - Long Island

Dr. Gra nt says. "It 's impor ta nt to plot the head circumference out on a g raph a nd see how the child ra nks according to other children of the sa me age." D u e t o t h e p e d i a t r i c i a n 's m e a - s u r e m e n t s o f t h e i n f a n t 's h e a d circumference, Dr. Gra nt wa s able to remove a huge posterior fossa cyst from the baby 's bra in, which was caused by a n infection. PRESENTATION IN YOUNG CHILDREN Ch i ld ren a ges 2 t o 6, a re somewhat bet ter able to a r ticu late when some- thing is wrong. The genera l rule is still " hea da ches plus," but one i nd icator that ca n sometimes be missed is vision impa irment. These children may just sta nd too close to t he T V because of impa ired vision. " Pa rent s have t o work out what a ch i ld's problem is by obser v i ng h i m or her," D r. Gr a nt s ay s . " Wa t c h i n g younger ch i ld ren play a nd how t hey use their ha nds is slightly more cha l- lenging than ta lking with older children about symptoms." One 5 -yea r-old boy presented w ith what might be considered classic symp- toms. He had headaches for six weeks, sta r ted throw ing up a nd then f ina l ly refused to eat. A f ter a CT sca n, he was diagnosed with an ependymoma, a brain tumor, which Dr. Gra nt removed a nd later treated with radiation. Since then, the child has completely recovered. PRESENTATION IN TEENAGERS Bra in tumors a nd vascula r ma lforma- tions can be diff icult to diagnose at any age. In genera l, school-age children may compla i n of nonspeci f ic sy mptoms, such a s headaches or stomach prob- lems, but t he compla ints a re usua l ly fa r le s s f re quent t h a n w it h a du lt s . Ch i ldren ra rely compla in of neck or back pa in — so when t hey do, adu lts should pay attention. "A child compla ining of neck pa in is a serious issue," Dr. Gra nt says. " There might be some non-neurosurgica l issue, but we have to dia g nose what that is. The sa me applies for back pa in." Types of Brain Tumors or Malformations in Children IN CHILDREN, MOST tumors form in the posterior fossa, with 70 percent in the bottom portion of the brain and 30 percent in the top portion, whereas in adults the opposite is true. The location can contribute to the difficulty of a procedure, particularly if the tumor or vascular malformation is in the brainstem, says John A. Grant, MD, FACS, BCh, MB, neurosurgeon and Director of Pediatric Brain Tumors with the Long Island Brain Tumor Center at Neurological Surgery, P.C. There are three main types of pediatric brain tumors. + Astrocytomas — These tumors are frequently benign and occur most often in infants. Some grade I tumors have five-year survival rates as high as 95 percent, and grade II tumors have survival rates of 80 to 85 percent, according to the American Cancer Society (ACS). + Ependymomas — Occurring most frequently in infants, these tumors tend to be malignant, particularly in infants. These tumors account for 5 percent of childhood tumors. The survival rate is 75 percent according to the ACS. + Embryonal — These tumors account for 10 to 20 percent of childhood tumors and are most common in younger children. Medulloblastomas are the most common forms of embryonal tumors. "They look, histologically, malignant but respond well to radiation and chemotherapy," Dr. Grant says. Embryonal tumors have a survival rate of 60 to 65 percent. A noncontrast CT scan helps physicians differentiate between these three types of tumors by their density. Astrocytomas are less dense than brain tissue, ependymomas are of equal density to the brain and medulloblastomas are hyperdense. Noncontrast CT scans can also identify rare tumors, such as a craniopha- ryngioma, which tend to have calcium in them and can cause vision problems. Overall, the five-year survival rate for pediatric brain tumors is 75 percent. But Dr. Grant — as well as the ACS — emphasizes that it's important not to put too much emphasis on the survival rate. "Are any of these tumors so bad that we just don't offer treatment?" Dr. Grant asks. "No. All of them respond at some level. Neurosurgery is a good idea for children with these types of tumors." TYPES OF MALFORMATIONS The prognosis is also positive for children who require neurosurgery for cavernous malformations and arteriove- nous malformations in the brain. "If you treat malformations successfully, there's no underlying tumor process," Dr. Grant says, "so they tend to do better with time." Many of these patients present with hydrocephalus or increased fluid on the brain, which increases intracranial pressure. Hydrocephalus can be congenital or can be caused by an infection. It can also be caused by a bleed, if the bleeding blocks off the circulation of cerebrospinal fluid. If left untreated hydrocephalus can cause stroke or death. Preoperative and postoperative images of an ependymoma, a rare primary brain tumor. Preoperative and postoper- ative images of a brain stem cavernous malformation. 0 8❱❱❱❱❱ C O V E R F E A T U R E

• Cover