Pediatric
supratentorial tumors represent about 50% of all
intracranial neoplasms. The most frequent
tumors of the cerebral hemispheres are
gliomas that arise from astrocytes, oligodendrocytes or ependymal cells. The incidence of the different histologic types is difficult to be established as many
tumors have a mixed cellularity, thus classification is based on the prevalent oncotype or the most malignant component.
Choroid plexus papillomas and
ependymomas are the most common ventricular
neoplasms. However, subependymal giant cell
astrocytomas,
subependymomas,
teratomas are also observed. The parasellar region is a frequent site of pediatric
tumors as
craniopharyngiomas, optic pathway
gliomas and
germinomas.
Pinealomas are less common. Signs and symptoms related to increased intracranial pressure are often reported and vary according to the patient's age. Macrocrania and a bulging fontanel can be observed in infants and toddlers, whereas
headache,
papilledema and
vomiting are present in the older children. A
tumor hindering CSF circulation may cause
hydrocephalus. Focal signs include
epilepsy and neurological deficits characteristic of
tumor location. Total removal of the
tumor is the ideal surgical
therapy. When eloquent areas are involved, partial exeresis is indicated.
Radiotherapy is usually administered to malignant
tumors even if in younger children its use in markedly limited by the possible severe side-effects on the developing brain.
Chemotherapy seems effective in some
brain neoplasms, however most suitable drugs and dose need to be established. It may represent an alternative to
radiotherapy in children less than three years of age.