Pediatric brain tumors are the most common solid tumors in children and the leading cause of childhood cancer–related neurological symptoms. They can arise from different brain regions — the cerebellum, brainstem, ventricles, or cerebral hemispheres — and vary from benign (slow-growing) to malignant (aggressive) forms. Advances in microneurosurgery, neuro-navigation, and intraoperative monitoring now allow safe tumor removal while preserving critical brain functions. Early diagnosis and a multidisciplinary treatment plan significantly improve survival and quality of life.
Symptoms
Symptoms depend on the tumor’s location, size, and growth rate. Because children’s skulls are still flexible, early signs may be subtle. Common symptoms include:
- Persistent headache, especially in the morning
- Nausea and vomiting not related to infection
- Balance or coordination problems (walking unsteadily, frequent falls)
- Visual changes (double vision, abnormal eye movements)
- Seizures or episodes of staring or unresponsiveness
- Weakness or numbness on one side of the body
- Behavioral or school performance changes
- In infants: rapid head growth or bulging fontanelle due to raised intracranial pressure
Early recognition and imaging are key to preventing irreversible neurological damage.
Common Types of Pediatric Brain Tumors
- Medulloblastoma: The most frequent malignant brain tumor in children; arises in the cerebellum and can spread via cerebrospinal fluid.
- Pilocytic Astrocytoma: Usually benign and slow-growing; often located in the cerebellum or optic pathways.
- Ependymoma: Originates from the ventricular lining; may block CSF flow, causing hydrocephalus.
- Brainstem Glioma: Infiltrative tumor affecting cranial nerves and vital functions; treatment focuses on control and symptom relief.
- Craniopharyngioma: Benign but locally invasive tumor near the pituitary gland, often causing hormonal imbalance and vision loss.
- Germ Cell Tumors: Develop near the pineal or suprasellar regions; often treatable with combined surgery and chemotherapy.
Diagnosis
Diagnosis begins with MRI of the brain, which determines tumor size, location, and its relation to vital structures. MRI with contrast and MR spectroscopy provide additional information about tumor composition. CT scans may be used in emergencies for rapid assessment of hydrocephalus. When safe, biopsy or surgical removal confirms the exact histological type.
Additional tests include:
- Endocrine and hormonal evaluation (for pituitary or suprasellar lesions)
- Ophthalmologic exam for vision-related symptoms
- CSF analysis to detect tumor cell spread in medulloblastoma or ependymoma
Treatment Options
- Microsurgical Tumor Resection: The primary treatment for most brain tumors is microsurgical removal using neuronavigation, intraoperative monitoring, and sometimes endoscopic assistance. The goal is maximal safe resection — removing as much tumor as possible while protecting vital brain areas. Intraoperative ultrasound or MRI guidance helps confirm complete removal.
- Endoscopic Surgery: For tumors within or near the ventricles, neuroendoscopic techniques allow minimally invasive removal or biopsy through a small opening. At the same time, endoscopic third ventriculostomy (ETV) can treat associated hydrocephalus.
- Chemotherapy and Radiotherapy: Depending on the tumor type and grade:
Chemotherapy is often used for malignant or residual tumors.
Radiotherapy may be applied in children over 3–5 years, with modern techniques (proton beam or conformal radiation) to minimize long-term effects on cognition and growth. - Targeted and Supportive Therapies: In some tumor types, molecular testing allows targeted therapies aimed at specific genetic mutations. Supportive care includes hormonal replacement, rehabilitation, and psychological support to aid recovery and learning.
Recovery & Follow-Up
After surgery, children are usually monitored in the neuro-intensive care unit for 24–48 hours. Most recover within 1–2 weeks, depending on tumor type and location. Long-term follow-up includes MRI every 3–6 months during the first years to detect recurrence or regrowth. Rehabilitation programs address motor, cognitive, and emotional recovery. Endocrine and visual follow-up are essential for tumors near the pituitary or optic chiasm.
When to See a Pediatric Neurosurgeon
If your child develops persistent headaches, vomiting, balance issues, or sudden neurological symptoms, a pediatric neurosurgical evaluation is crucial. Early diagnosis enables curative surgery and minimizes long-term neurological deficits.