What Parents Should Know About Brain Tumors in Children

After leukemia, brain tumors represent the most common type of cancers in children. In 2013, there were over 4,000 newly diagnosed pediatric brain tumors in the United States; over 3,000 occurred in children under the age of 15. Dr. Chesler, a fellowship-trained expert on childhood brain tumors, is one of fewer than 200 actively practicing pediatric neurosurgeons in the United States. 

What are the most common brain tumors in children?
Most brain tumors in children are primary, meaning they develop in the brain and usually do not spread to other parts of the body. They can be life-threatening if they grow in a vital area within the brain and can also press on other parts of the brain that control body functions. The most common brain tumors in children under the age of 15 are pilocytic astrocytoma (usually slow growing and benign), medulloblastoma — a type of embryonal (rapidly growing) tumor that is also known as a primitive neuroectodermal tumor (PNET) and ependymoma (cancerous) tumors. Over the age of 15, pituitary (usually noncancerous) tumors and pilocytic tumors are the most common.  

What are the symptoms?
Benign or slower growing brain tumors tend to have more subtle symptoms, while malignant/ fast growing tumors tend to have more severe  symptoms. Younger patients may be unable to tell a parent or doctor that there is a problem, which can cause a delay in diagnosis. Symptoms, which vary depending on age, location and size of the tumor, may include:  

• Headache
• Hydrocephalus (known as water on the brain)
• Nausea and/or vomiting; failure to thrive
• Blurry vision
• Cranial nerve palsy(s)
• Sleepiness/lethargy
• Numbness and/or weakness
• Scoliosis (symptom of a spinal cord tumor)
• Gross and/or fine motor delays
• Bowel and/or bladder dysfunction

How are children diagnosed?
There are several tests that may be recommended to diagnose a brain tumor in a child. These include: neurological exams, magnetic resonance imaging (MRI), computed tomography (CT) scan, cerebrospinal fluid examination or positron emission tomography (PET) scan. A sterotactic biopsy, in which a tissue sample is removed from the child’s brain, using MRI guidance may also be performed.  

What treatment options are available?
The primary goal of treatment is to remove as much of the tumor as possible or to slow the tumor’s growth with as little harm to the child’s brain as possible. Treatment options, outcomes and recovery depend on a variety of factors, which include: 

• Child’s age
• Child’s general health
• Tumor location
• Amount of tumor remaining after surgery
• Whether the cancer has spread to other parts of the brain or parts of the body

Once a tumor has been diagnosed, a surgeon may consider one or more of the following treatment options:

• Ventriculo-peritoneal shunt placement surgery — in which excess fluid is drained by placing a small plastic tube called a shunt in the brain
• Surgery — to remove as much of the tumor as possible through a hole in the skull
• Radiation therapy — using high-energy rays to prevent cells from growing and dividing, which may be performed before or after surgery, and may be used in conjunction with chemotherapy.
• Chemotherapy — often used to treat tumors that are difficult to remove or are highly aggressive

What is different about Stony Brook Children's approach?
At Stony Brook Children’s, our entire focus is children. Our comprehensive team of pediatric experts includes neurosurgeons, neuroradiologists and neurointerventional radiologists, pediatricians, pediatric intensivists, pediatric oncologists, radiation oncologists, pediatric nurses, child life specialists and social workers. Also, as part of Suffolk County’s only academic medical center, we have access to the most advanced technology available. For example, using a technique called neuronavigation, we are able to plan a precise surgical approach to a targeted area to preserve healthy brain surrounding the tumor. In addition, intraoperative neurophysiologic monitoring may be used to protect a child’s nervous system during surgery to help reduce the risk of postoperative complications. We also use the latest techniques to minimize invasiveness and to limit blood loss.  

To learn more about pediatric brain tumors and Stony Brook Children’s Hospital, call (631) 444-KIDS (5437).