COVID-19 – 

Coronavirus information and updates from RWJBarnabas Health.

TEMPORARY VISITATION POLICY CHANGE:

Pediatric Brain Tumors

If your child has symptoms of a brain tumor or has already been diagnosed, you have plenty of questions. How will it affect his or her life? Will s/he live to adulthood? Some pediatric brain tumors can cause long-lasting impairments to intellectual ability and neurological function, due to the fact that a child’s brain is still developing and growing. Whether or not pediatric brain tumors are cancerous, they can have permanent, life-altering effects on the child’s physical, mental, neurological, intellectual, and psychological functions. However, many children with brain tumors go on to live fulfilling lives well into adulthood.

The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health, treats pediatric brain tumors in our Pediatric Neurology & Neurosurgery Department. When it comes to treating children, we are pleased to treat pediatric brain tumors utilizing a team of multidisciplinary, board-certified physicians and expert support staff. Just a few of the members of our Pediatric Neurosurgery Program include experts in every pediatric field, including: oncology, neurology, neuro-oncology, radiology, pathology, anesthesiology, cardiology, endocrinology, intensive care, neonatology, orthopedics, otolaryngology, surgery, plastic surgery, rehabilitative medicine, and more. These physicians are specifically trained to treat illness and injury in children, and neurologists in particular are specialists of the brain and nervous system of children.

What Are Pediatric Brain Tumors?

Brain tumors in children start from abnormal masses of cells that have grown out of control. As the tumor continues to grow, it can be life-threatening and may spread throughout the brain and into the spinal cord tissue.

According to the American Cancer Society, the main concerns of a brain tumor in a child are:

  • How fast the tumor is growing

  • The exact site of the tumor

  • Whether the tumor has spread or will spread throughout the brain and spinal cord

  • If the tumor is removable through surgery or stereotactic radiosurgery

  • If the tumor has a chance of recurrence

Where Pediatric Tumors Occur in the Brain and/or Spinal Cord

Brain and spinal cord tumors are classified by location and grade. These tumors may occur in the following areas:

  • Cerebellum: The lower back of the brain controls functions such as balance, coordination and fine motors skills.

  • Cerebrum: The large, outer part of the brain controls thoughts, speech, emotions, learning, voluntary movements, and the senses.

  • Brainstem: The bottom area of the brain connects the large outer part (the cerebrum) to the spinal cord and controls involuntarily bodily functions and movements.

  • Spinal cord: More rarely, brain tumors spread to the spinal cord. This long tube of nerves starts in the brain and goes down the length of the spine, throughout the spinal column. It carries messages to the brain. Spinal cord damage is permanent, and may cause partial or full paralysis.

Pediatric Brain Tumor Types

Pediatric tumors are categorized in numerous ways. They may start in the brain (primary brain tumors), be metastatic (the tumor spread from another part of the body to the brain), be benign (non-cancerous and slow-growing), or be malignant (cancerous, and these tumors can be very aggressive and require intensive treatment).

They are named by “type,” for which type of cell grew out of control into a tumor (some even have a mixed type). They are also categorized by “grade.” Grade indicates the tumor’s likeliness to grow and spread into nearby tissues, and how quickly. Typically, these tumors are graded on a scale of I to IV (1 to 4), based on how the tumor appears under a microscope. The higher the grade of the tumor, the more likely it is to grow and require much more intensive treatment.

There are numerous types of pediatric brain tumors, both benign and cancerous, and they each affect the patient differently. The following are the four most common pediatric brain tumors:

  • Medulloblastomas are the most common pediatric brain cancer, and most occur before age 10. They start in the cerebellum. Some medulloblastoma patients have a better outlook than others.

  • Astrocytomas are a type of glioma tumor, which is a general term for the group of brain tumors originating in the glial cells. Astrocytomas, specifically, are a kind of glial call called “astrocytes,” which support and nourish nerve cells.

  • Ependymomas can be benign or cancerous. The site of the tumor will determine the type of therapy the patient requires to control the tumor removal, if possible. They are very rare, accounting for only about 5% of brain tumors in children.

  • Optic nerve gliomas: This is a subtype of astrocytomas and they start in the nerves leading from the back of the eyes to the brain (the optic nerve). They usually grow slowly, and they are usually caused by an inherited condition called neurofibromatosis type I. While these tumors are rarely fatal, they may cause blindness and brain injury.

Is a Pediatric Brain Tumor Cancerous?

For most bodily tumors, it’s very important to make the distinction between whether a tumor is benign (noncancerous) or malignant (cancerous). In children, though, it’s important to understand that both benign and malignant diagnoses are harmful, as children’s bodies and brains continue to grow and develop, and brain tumors can push on areas of the brain and compromise the function of those brain cells.

Benign pediatric brain tumors are not harmless. As they grow, they push onto other areas of the brain and spinal cord and can cause serious, even permanent brain damage. This is because brain tumors can directly destroy the function of the brain cells the tumor is pushing on, leading to swelling and increased pressure within the skull.

Malignant pediatric brain tumors are also dangerous, but on top of that, they are cancerous and can spread to other parts of the body. These tumors are slightly more common in boys, while benign tumors are more likely in girls.

What Causes Pediatric Brain Tumors?

The cause of primary pediatric brain tumors (those which originate in the brain) remains largely unknown.

Some of the possible risk factors for developing a brain tumor as a child include radiation exposure, or having an inherited condition. Some inherited conditions put a child at increased risk for certain types of brain tumors. The following inherited conditions may cause pediatric brain tumors: neurofibromatosis types 1 and 2, tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and other syndromes.

How Common Are Pediatric Brain Tumors?

Nationwide, there are an estimated 700,000 adults and children living with a brain tumor, and approximately 79,000 of them were newly diagnosed in 2018 alone. Of those individuals diagnosed with brain tumors, more than 5,000 were children, according to the American Cancer Society.

How Are Pediatric Brain Tumors Diagnosed?

If your child is experiencing brain tumor symptoms, it’s important that she or he be seen immediately by a pediatrician or pediatric neurologist in an emergency room, to rule out any other medical problems and diagnose a brain tumor.

Your child’s doctor will ask for a family medical history, perform a neurological exam, and perform imaging scans such as magnetic resonance imaging (MRI) scans. A functional MRI provides the doctors with images of the brain and can locate the site of a brain tumor. This provides the pediatric neurosurgeon with a sort of “map” of where the tumor is located, and then, how best to remove and/or treat it.

The only way to definitively diagnose a brain tumor is to remove a sample of tumor tissue to test it. Your child’s pediatric neurosurgeon will drill a small hole into the skull, insert a thin needle, and remove tissue using the needle. Then, the biopsy sample will be analyzed by a neuropathologist to determine the cell types and grade of the brain tumor, as well as whether it is benign or malignant.

Symptoms of a Pediatric Brain Tumor

Because the human skull has no excess room for anything other than protecting the brain, it cannot accommodate the size and spreading of a brain tumor. Eventually, the extra pressure in this closed space (intracranial pressure) can block the cerebrospinal fluid flow pathways and impede the functions the brain carries out.

Symptoms of pediatric brain tumors vary, but generally include:

  • Severe, chronic headaches

  • Seizures

  • Chronic nausea and vomiting

  • Irritability

  • Lack of appetite

  • Double vision

  • Abnormal eye movement

  • Confusion

  • Hearing problems

  • Drowsiness, fatigue, low energy

  • Loss of motor coordination

  • Mood swings or apathy

  • Personality changes

  • Forgetfulness

  • Learning difficulties

  • Enlarged head, especially in infants whose skull bones were not properly fused

Pediatric Brain Tumor Treatment

The main treatments for pediatric brain tumors include surgery, radiation therapy, chemotherapy, targeted therapy drugs, and drugs to help alleviate symptoms. Most often, the goal for the neurosurgeon is to remove or destroy as much of the tumor as possible without impairing normal brain and/or nerve function. Children with inoperable brain tumors may be treated instead with radiation therapy. If the tumor is deep within the brain and has already spread, other palliative treatments may be utilized.

Craniotomy Surgery for Pediatric Brain Tumors

This surgery is performed by making a sort of keyhole into the skull to access the brain. It is the most common surgery for brain tumor removal. Your child will either be placed under general anesthesia (a deep but reversible state of unconsciousness) or remain awake with local anesthesia for at least part of the surgery, if brain function must be assessed during the operation.

To begin a craniotomy, the child’s head is partially or fully shaved to make an incision in the scalp over the skull near the tumor; then, a medical drill is used to remove a piece of the skull bone large enough to insert surgical instruments to view the parts of the brain from which the tumor will be removed. The pediatric neurosurgeon will use an MRI or other imaging technology during the surgery itself to show any of the remaining tumor that cannot be removed safely without impeding brain and/or spinal function.

Once the tumor is partially or fully removed (depending on the physician’s decision of how it will impact the rest of the brain’s function), the skull bone is replaced, and the incision is closed.

There are risks of craniotomy surgery, because it is a serious operation. Your child’s neurosurgeon will take all necessary steps to limit any problems during or after surgery is complete, such as bleeding, infections, seizures, or adverse anesthesia interactions. Brain swelling is very common and a major concern after surgery, but drugs called corticosteroids are given before and after the surgery to help lessen the associated risk of a seizure.

Another notable risk is that removing a brain tumor can result in loss of function to the affected brain cells, which is why our pediatric neurosurgeons will be extremely careful and remove only as much of the tumor tissue as is safe and necessary. If the physician determines that part or all of the brain tumor is inoperable, there are other treatments for extending and/or improving quality of life.

Radiation Therapy for Pediatric Brain Tumors

Radiation uses high-energy, carefully targeted x-rays to kill some tumors. Usually, this treatment is reserved for children older than 3 years, because it can affect brain development. It can even affect older children, but our pediatric radiation oncologists do their utmost to ensure they deliver enough radiation to the tumor while limiting exposure to normal, surrounding tissues.

This treatment is given by a pediatric radiation oncologist. Radiation therapy is not given to every pediatric brain tumor patient, but it may be used after surgery to kill any remaining tumor cells from inoperable regions of the brain, or as part of the primary treatment if surgery is not an option. Radiation therapy can also prevent or relieve symptoms caused by the tumor.

There are many types of radiation and ways to treat pediatric brain tumors through radiation, as explained on the American Cancer Society website.

Chemotherapy for Pediatric Brain Tumors

Chemotherapy, often called chemo, kills cancer cells and is usually administered intravenously or taken in pill form by mouth. These drugs enter the bloodstream and can reach almost all areas of the body; however, many chemo drugs cannot pass the blood-brain barrier and, as such, chemo is not utilized for every pediatric brain tumor patient. It is useful, however, to give chemo to patients directly into their cerebrospinal fluid (CSF, the nourishing fluid bathing the brain and spinal cord). It is administered through a catheter, which is inserted through a hole in the skull during a minor operation. Chemo is generally used for faster-growing, more aggressive brain tumors.

Pediatric Brain Tumor Prognosis (Outlook)

Of all children with brain tumors, both malignant or benign, about 75% will survive at least 5 years upon diagnosis. The outlook can vary greatly depending on the type of tumor, where it is located in the brain and/or spinal cord, and other factors, like the child’s overall health. Survival rates vary by tumor type, according to key statistics compiled by the American Cancer Society.

Contact Our Pediatric Neurology & Neurosurgery Department

Request an appointment online now or call 833-656-3876.