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Paediatric Brain Tumours

What is Brain Tumour?

A brain tumor occurs when there is a genetic alteration in the normal cells in the brain. The alteration causes the cells to undergo a series of changes that result in a growing mass of abnormal cells. Primary brain tumors involve a growth that starts in the brain, rather than spreading to the brain from another part of the body.

Brain tumors may be low grade (less aggressive) or high grade (very aggressive). The cause of primary brain tumors is unknown, although some tumors have germ line mutations and tend to be hereditary. The majority result from somatic mutations and are not hereditary.

Central nervous system tumors (tumors of the brain and spine) are the most common solid tumor in children. There are approximately 4,500 new brain tumors each year, and they are the most common cause of cancer deaths.

Common Brain and Spinal Cord Tumors in Children

The most common types of brain and spinal cord tumors in children are medulloblastomas and gliomas, which include:

    • Astrocytomas
    • Brain stem gliomas
    • Ependymomas
    • Optic nerve gliomas

Other Brain and Spinal Tumors Found in Children

    • Choroid plexus tumor
    • Craniopharyngioma
    • Dysembryoplastic neuroepithelial tumor
    • Germ cell tumor
    • Spinal cord tumor

More than 500 new cases are diagnosed with primary brain tumour everyday worldwide and even more are diagnosed with metastatic brain tumour. Incidence & prevalence of brain tumour is growing in India.

Locations of Brain and Spinal Cord Tumors in Children

Brain and spinal cord tumors in children are also classified by their location within the brain. They may occur in the:

    • Cerebellum — the lower, back part of the brain, which controls balance, coordination and fine muscle control (e.g., walking).
    • Cerebrum — the large, outer part of the brain, which controls thought, learning, speech, emotions, planned muscle movements, and the senses.
    • Brainstem — the bottom part of the brain, which connects the cerebrum to the spinal cord and controls many basic body functions and movement.
    • Spinal cord — a long, tube-like bundle of nerves that starts in the brain and goes down the length of the spine, and carries messages to and from the brain.

Signs and Symptoms

The symptoms of a pediatric brain tumor vary according to the size, type and location of the tumor. Symptoms may occur when a tumor presses on a nerve or damages certain parts of the brain. They may also occur when the brain swells or there is fluid buildup in the skull. The most common symptoms include:

    • Headaches (usually worse in the morning)
    • Nausea or vomiting
    • Changes in speech, vision or hearing
    • Problems balancing or walking
    • Changes in mood, personality or ability to concentrate
    • Problems with memory
    • Muscle jerking or twitching (seizures or convulsions)
    • Numbness or tingling in the arms or legs

How are Brain Tumours Diagnosed?

After taking a complete medical history and doing a physical examination of your child, we may use the following diagnostic tests to determine if a brain tumor is present:

Neurological exam - Our Neurosurgeon will test reflexes, muscle strength, eye and mouth movement, coordination and alertness.

Computerized Tomography scan (CT scan) - This imaging procedure used to produce cross-sectional images (called 'slices') — both horizontal and vertical — of the bones, muscles, fat and organs.

Magnetic resonance imaging (MRI) - This imaging procedure uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

Angiogram - This imaging test uses a dye to visualize all the blood vessels in the brain to detect certain types of tumors.

Lumbar Puncture/Spinal tap - For this procedure, a special needle is placed into the lower back and into the spinal canal around the spinal cord. A small amount of cerebrospinal fluid, which surrounds the brain and spinal cord, can be removed and sent for testing.

Magnetic Resonance Spectroscopy (MRS) is used to examine the tumor's chemical profile and see whether the tumour is responding to treatment.

PET scan can help detect recurring brain tumours.

What are the Treatments for Brain Tumours?

Surgery is usually the first step in treating brain tumors in children. Our goal within the Pediatric Neurosurgery Program is to remove all or as much of the tumor as possible without damaging critical neurological function. Pediatric brain tumor patients have a particular advantage when coming to Brain & Spine Hospital because of the extensive experience of our neurosurgeons and the close collaboration between neurosurgery, neuro-oncology, radiation oncology and diagnostic radiology.

Certain types of brain tumors located near the bottom of the skull, also called skull-base tumors, can be removed through the nose using tools called endoscopes. Because the base of the skull is close to the nostrils and roof of the mouth, your child’s surgeon can access the tumor more easily and safely with endoscopic endonasal surgery by going through the nostrils, minimizing the need for more invasive procedures.

Surgery is also performed for a biopsy — a sample of tissue taken to examine the types of cells found in the tumor. This helps establish a diagnosis and treatment plan. This is frequently done when the tumor is surrounded by sensitive structures that may be damaged by surgical removal.

Radiation therapy and chemotherapy are generally used as secondary treatment for tumours that cannot be cured through surgery alone.

At Brain & Spine Hospital, every patient being treated for a brain tumor is offered the opportunity to have their life back. They can live a normal life.

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