Narayana Health Care

Causes of brain tumours in children:

Brain tumours are very rare among children. The cause of primary brain tumours is usually unknown. Some brain tumours are genetic, and they run in the family or are a part of syndromes.

Brain tumours are classified based on the location, the cell of origin of the tumour, and whether the tumour is cancerous or not.

Brain tumours can directly damage brain cells or cause neurological symptoms by compressing adjacent normal brain tissue. This also causes swelling and an increase in pressure within the skull.

Most pediatric tumours have a predilection for a certain age group.

Common pediatric brain tumours:

Astrocytomas – These are usually non-malignant slow-growing tumours that can be seen in children. Usually seen between the ages of five to eight, these tumours are the most common pediatric brain tumours. They are also known as low-grade gliomas.

Medulloblastomas – Most often, these tumours occur before the age of ten years. They are malignant and are found in the cerebellum, which is present posteriorly within the skull. It is the most common cancerous tumour in childhood.

Ependymomas – These tumours may or may not be malignant. Treatment for these tumours depends on the location of the tumour.

Brainstem gliomas – These are very rare and occur only in children. They usually develop around the age of six years. The tumour may grow very large before symptoms manifest.

Symptoms of brain tumours in children:

Headaches are the most common symptom among children with tumours. However, very rarely does a headache in a child mean brain tumour. Few headache patterns that may occur with brain tumours include:

• Headaches that are the worst when you wake up and slowly fade away within a few hours of waking up
• Headaches that worsen with coughing or exercise or due to change in your body position.
• Headaches that occur in your sleep, accompanied by one other symptom such as confusion or vomiting.

Sometimes, brain tumours may only have mental changes as symptoms such as:

• Inability to concentrate
• Increased sleep
• Changes in behaviour and personality
• Loss of memory
• Problems with reasoning

Other possible symptoms include:

• A gradual loss of sensation or movement in an arm or leg
• Unexplained frequent vomiting
• Loss of hearing
• Difficulty in speech
• Partial or complete vision loss in one or both eyes
• Difficulties in balancing
• Weakness or numbness in any region

Examinations and tests:

A physical examination of the young child suspected to have a brain tumour is done to look for signs like:

• Enlarged eyes, caused by the tumour pushing the eyeballs outwards.
• Loss of red reflex in one or both eyes, due to compression of neurons
• Separated sutures, due to increased pressure from the tumour
• Positive Babinski reflex, when the tumour is affecting the cerebellum
• Bulging fontanelle, due to compression and increased pressure inside the skull

Older children will show signs such as:

• Changes in vision
• Altered gait, or how the child walks
• Weakness in a part of the body
• A head tilt

Diagnosing brain tumour in a child:

This involves tests to visualise the tumour, identify its exact location and also estimate its extent of spread.

Tests used include:

• Computed Tomography or CT scan
• Magnetic Resonance Imaging or MRI scan

Additional tests like examination of the cerebrospinal fluid may also be done.

Treatment modalities for pediatric brain tumours

Treatment plans are made depending on the size and type of the tumour and the general health of the child. The treatment aims to either cure the tumour, relieve symptoms, improve the functioning of the brain or for better comfort for the child.

Surgery is usually the primary modality of treatment for pediatric tumours. Most tumours are completely cured by surgery. Some tumours may require other forms of therapy, but surgery is still performed first to remove the majority of the tumour burden and relieve symptoms.

Few examples of treatments for specific tumours are as follows:

• Astrocytomas: Surgery is the mainstay of treatment. Radiotherapy and chemotherapy may be done for tumours at a higher stage or with additional risk factors.
• Brainstem gliomas: These tumours are located deep within the brain and cannot be operated on. Radiation and chemotherapy is used to treat these tumours.
• Medulloblastomas: Chemotherapy, with or without radiation, is used in combination with surgery for such tumours.

Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve the quality of life.

Prognosis of pediatric brain tumours

The response of a child being treated for a brain tumour depends on many factors, including the type of tumour, the extent of spread of the tumour and the general health of the child. Statistics say that three out of four children survive for at least five years after diagnosis.

Long-term consequences such as neurological problems and difficulties in paying attention, focusing on things, loss of memory, loss of initiative may occur. Younger children, especially below three years of age, are especially at risk for such complications. Parents need to ensure the child gets the necessary support at home and in school.

Dr. Shibu Vasudevan Pillai | Senior Consultant – Neurosurgery | Mazumdar Shaw Medical Center, Bommasandra & Narayana Multispeciality Clinic, Electronic City – Velankani