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Neurology and Neurosurgery

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Brain Tumors in Children

What is a brain tumor?

Each year, close to 2,000 children are diagnosed with brain tumors. Also called neoplasms, brain tumors are among the most common solid tumors in children and adolescents. Because of the location, significant long-term impairment to intellectual and neurological function is possible. They can also be life threatening if not treated promptly.

Brain tumors can be categorized as malignant (cancerous), benign (non-cancerous), primary (starting in the brain) or metastatic (starting in other parts of the body and spreading to the brain). Unlike benign tumors that tend to stay contained, malignant tumors are very aggressive. They grow rapidly and can spread to areas near the original tumor and to other areas in the brain.

Types of brain tumors in children

The most common types of brain tumors in children are:

  • Medulloblastomas/PNET (primitive neuroendocrine tumors) – malignant tumors of the central nervous system arising in the cerebellum
  • Astrocytomas – arising from the essential cell of the brain (astrocyte cells)
  • Ependymomas – arising from the cells that support, nourish, make myelin and line the ventricles that cerebrospinal fluid flows through
  • Craniopharyngiomas – occurring near the pituitary gland

Learn more about other types of brain tumors in children at the Johns Hopkins Pediatric Brain & Spinal Tumor Center.

Symptoms of brain tumors in children

The skull does not have excess room for anything other than the brain. Therefore, as brain tumors develop and expand, extra pressure is created. This is called intracranial pressure (ICP). Elevated ICP is caused by extra tissue in the brain as well as blockage of the cerebrospinal fluid (CSF) flow pathways. Symptoms include:

  • Headaches
  • Nausea and vomiting
  • Irritability
  • Lethargy and drowsiness
  • Personality and mental activity changes
  • Depression
  • Coma and death, if left untreated
  • Macroencephaly (big heads) in infants whose skull bones are not completely fused

Additional symptoms related to brain tissue dysfunction caused by a growing tumor may be seen. These symptoms depend on the location of the tumor. For example, if it is located in the cerebellum at the back of the head, a child may have trouble walking or experience balance and coordination problems. If the tumor affects the optic pathway, which is responsible for sight, they may experience vision changes.

Learn more about signs and symptoms of brain tumors in children at the Johns Hopkins Pediatric Brain & Spinal Tumor Center.

How is a brain tumor diagnosed in children?

If a child experiences the symptoms above, a thorough evaluation by a pediatrician or neurologist is needed to diagnose the root of the problem. This evaluation usually includes imaging of the brain through an MRI. If the MRI shows a brain tumor, a neurosurgical consultation is recommended to develop the best treatment plan. Depending on the location of the tumor, additional specialists may be consulted in developing the treatment plan. If the tumor is located along the vision pathways, for example, an ophthalmologist may join the team.

Learn more about diagnosing brain tumors in children at the Johns Hopkins Pediatric Brain & Spinal Tumor Center.

Treatment for brain tumors in children

The Johns Hopkins difference involves multiple specialties to review the cases of children with brain tumors. Neurosurgeons, pediatric oncologists, radiation oncologists, among others, join together to develop the treatment plan. The team will decide whether surgery, radiation therapy or chemotherapy is the best option, or if a combination of these approaches will be more effective.

  • Surgery – the purpose of surgery is to remove as much tumor as possible and relieve intracranial pressure caused by the tumor. For low-grade or slow-growing tumors, this is the only intervention necessary.
  • Radiation Therapy – this therapy focuses beams of high energy light on the tumor tissue and a small amount of surrounding tissue. This can control the invasiveness of the cancer. Stereotactic radiation treatments, available for specific types of tumors, can eliminate the tumor without surgery.
  • Chemotherapy – this is used for aggressive, high-grade tumors. The Johns Hopkins difference is also the use of advanced technology, like our intraoperative MRI. This technology allows us to do our jobs with more precision. We can now see and address any stray cancer cells or slivers of tumor that are hard to detect before leaving the operating table. Follow-up care is extremely important in tracking the progress of a child’s recovery.

Treatment options and long-term outcome in pediatric patients vary depending on cell type, grade of the tumor and the location in the brain. Learn more about treatment for brain tumors in children at the Johns Hopkins Pediatric Brain & Spinal Tumor Center.

Grade – The grade refers to how aggressive the tumor cells appear to be. The higher the grade, the more aggressive the tumor.

Location – Because there are many vital structures in the brain, there are portions that are not surgically accessible. Careful evaluation is necessary to determine the accessibility of the the tumor.

Cell type – To determine what kind of tissue or cell type the tumor arose from, physicians will look at the tumor under a microscope.

Follow-Up Care

The recovery process is different for each patient. Children who received prompt diagnosis and treatment do well after surgery. Some may experience some temporary neurological deficits, such as muscle weakness. In most cases, this goes away shortly after surgery, unless there was substantial permanent damage before the child was diagnosed. Physical therapy will help improve strength, function and speed of recovery.

Most children are able to go home shortly after surgery, requiring only pain medications while the surgical site heals. They should be encouraged to assume their regular daily activities, like school, social events and play. Physical activities should be encouraged as tolerated. Other specific treatment recommendations made by the neurosurgeon should be followed carefully.

Regular post-operative follow-up visits with the child’s neurosurgeon are also important. This allows the neurological function, tumor recurrence and side-effects from chemo-radiation therapy to be monitored carefully.

To request a consultation or make an appointment, please contact Johns Hopkins Pediatric Neurosurgery at 410-955-7337.

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