The role of surgery in pediatric gliomas

Pediatric glial tumors differ from adult gliomas in several ways that are o f major therapeutic importance. First, the value of extensive tumor resecti on, which is controversial for malignant intrinsic brain tumors in adults, has been confirmed for a variety of childhood brain tumors, such as suprate ntorial high-grade and low-grade gliomas and infratentorial low-grade gliom as, ependymomas, and some medulloblastomas. Second, chemotherapy has been f ound to be effective in improving overall outcome in several childhood brai n tumors, such as medulloblastoma and supratentorial high-grade glioma, but has yet to be proven to have a major benefit for adult tumors. In addition , chemotherapy is increasingly used to delay or avoid radiotherapy in young children with high-grade and incompletely resected low-grade tumors to avo id the morbidity of irradiation on the developing nervous system. Third, th e prognosis for histologically similar tumors is often more favorable in ch ildren than adults. The present chapter will highlight the unique features of childhood glial tumors, discuss general principles in the clinical prese ntation, diagnostic evaluation, and treatment of these tumors, and then foc us on the surgical management and outcome of the more common types of tumor s.