Children with brain or spinal cord tumors require special care because their brains and bodies are still developing. The treatment will depend on many factors, including:
- The location of the brain or spinal cord tumor
- Whether it is benign or malignant
- The child’s age and general health
- The parents’ preferences regarding treatment options
- The risks associated with a particular treatment
Surgery is the most common treatment for children with brain and spinal cord tumors. If the child’s tumor is benign and in a part of the brain where neurosurgeons can safely completely remove it, surgery is likely to be the only treatment needed.
Doctors commonly use radiation therapy after surgery for tumors that neurosurgeons cannot completely remove and for the most malignant tumors. Radiation therapy may also used to treat tumors in locations where surgery is not safe. However, radiation therapy is not used in very young children because it may affect the developing brain.
If the tumor is malignant and growing rapidly, doctors may recommend chemotherapy.
For a small brain or spinal cord tumor that does not cause any significant signs or symptoms, monitoring the tumor without any immediate treatment, called observation, may be an option. If the tumor does not grow, the child may not need treatment.
Understanding the treatment options
A pediatric neurosurgeon who specializes in brain and spinal cord tumors in children will head up the brain tumor care team. The neurosurgeon, with a physician assistant, will help the parents understand the brain tumor. They will discuss the recommended treatment plan and other options so that the parents can make good decisions about care.
Receiving care and support
A physician assistant will work closely with the neurosurgeon to coordinate each child’s care. This includes scheduling appointments to see other doctors at Johns Hopkins or for tests or treatments. The parents will receive written information about brain tumors, treatments, Johns Hopkins and support services.
The most common type of surgery to remove a brain tumor in a child is called a craniotomy. This procedure involves making an incision in the scalp and removing a piece of bone from the skull. The neurosurgeon can then find and remove the tumor, or as much of the tumor as possible without risk of severe damage to the brain. The neurosurgeon then replaces the bone and closes the incision. For tumors in locations other than the brain, surgical approaches are tailored to the location of the tumor in order to gain access to it.
Ways Johns Hopkins Improves the Results of Surgery
Our neurosurgeons use state-of-the-art imagining and surgical techniques to improve the results (outcomes) of surgery for pediatric brain and spinal cord tumors. These techniques let neurosurgeons precisely plan and perform surgery, using the least invasive approach possible. They include:
- Intraoperative imaging uses special MRI or CT scan machines in the operating room to help neurosurgeons remove brain and spinal cord tumors safely and effectively
- Image-guided stereotactic surgery is a procedure which uses advanced computers to find a brain or spinal cord tumor and create a three-dimensional image of it to help neurosurgeons remove the tumor safely and effectively
- Intraoperative brain mapping (awake brain surgery) is performed while the patient is awake but sedated to remove tumors that would otherwise be inoperable
- Neuroendoscopy, a minimally invasive procedure to remove some brain and spinal cord tumors through a small hole in the skull or through the mouth or the nose using small cameras and instruments.
After surgery, a team of doctors and nurses who are specially trained in pediatric critical care will assist with the child's recovery. Before the child leaves The Johns Hopkins Hospital, they will provide the parents with detailed instructions about what to do at home.
Radiation therapy is the treatment of tumors using X-rays and other forms of radiation (light energy) to destroy cancer cells or prevent the tumor from growing. It is also called radiotherapy.
Radiation therapy is often not used in very young children because it may affect learning, development and memory. If radiation therapy is recommended, a radiation oncologist will discuss the benefits and risks of the treatment for the child.
Two types of radiation therapy are used to treat brain and spinal cord tumors in children:
- External beam radiation therapy
- Stereotactic radiosurgery
External beam radiation therapy delivers radiation from outside the body, using a machine called a linear accelerator. It can be directed to the brain or spinal cord tumor and nearby areas.
Stereotactic radiosurgery, such as the cyberknife, uses narrow beams of radiation coming from different angles to precisely deliver radiation to a brain tumor while sparing the surrounding normal areas of the brain. Also called stereotactic radiotherapy, stereotactic radiosurgery delivers a higher dose of radiation than external beam radiation therapy. It can be performed in one or many doses.
Observation means that the child will see a neurosurgeon and have imaging tests done every three to six months. Treatment may be necessary later, for example, if a tumor grows or symptoms worsen.
Specific treatments for common brain and spinal cord tumors in children
- The primary treatment for an astrocytoma is surgery.
- If a low-grade tumor cannot be completely removed and the tumor grows, radiation therapy or chemotherapy may be recommended.
- For high-grade tumors, a combination of surgery, radiation therapy and chemotherapy is often necessary.
- Surgery is the first step in treating an ependymoma.
- Radiation therapy is usually recommended after surgery for older children.
- Treatment usually includes a combination of surgery, radiation therapy (except in the very young) and chemotherapy.