A MODERN ANALYSIS OF INTRACRANIAL TUMORS OF INFANCY

Objective: The management results of pediatric brain tumors should hav e improved with progress in neurosurgery, intra-and perioperative care , and adjunctive therapy. We assessed the outcomes of 88 consecutive c hildren under 2 years of age with brain tumors managed in the modern e ra, primarily by two neurosurgeons, and compared the results within th e study group over time and to historical controls. Methods: Medical r ecords were reviewed for diagnosis, location, surgery, surgical morbid ity and mortality, adjunctive therapy, and long-term results. Outcomes were available on all 88 patients. Results: Primitive neuroectodermal tumors, astrocytomas, ependymoma, and choroid plexus papillomas in de scending order of frequency accounted for two thirds of tumors. Suprat entorial location predominated (60%), although in the I-to 2-year grou p, there was a slight majority of infratentorial tumors. Surgical mort ality and immediate morbidity were 9 and 26%, respectively, with subst antial improvements in the last half of the series (2 and 16% with lon g-term morbidity of 11%). 53 of 88 (60%) of our patients are alive, an d all children treated since January 1, 1994, except for 1 operative d eath, remain alive. Conclusion: Children less than 2 years of age rema in a multidisciplinary challenge. Improved neuroimaging, surgical and pediatric intensive care management, and neuro-oncological care seems to have improved outcome both with respect to tumor control and neurol ogical function. Aggressive surgery is possible with a good outcome ge nerally expected. Hopefully this will set the stage for either surgica l cure in children with benign tumors or combined surgical and adjunct ive cure in patients with malignant tumors.