Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ The classic triad of morning headache, vomiting, and papilledema is present in less than 30% of children at presentation School failure and personality changes are common in older children Irritability, failure to thrive, and delayed development are common in very young children Recent-onset head tilt can result from a posterior fossa tumor +++ General Considerations ++ Account for 1500–2000 new malignancies in children each year in the United States and for 25–30% of all childhood cancers Brain tumors in childhood are biologically and histologically heterogeneous, ranging from low-grade localized lesions to high-grade tumors with neuraxis dissemination The risk of developing a brain tumor is increased in children who received cranial irradiation for treatment of meningeal leukemia +++ Classification ++ About 50% of the common pediatric brain tumors occur above the tentorium and 50% in the posterior fossa In the very young child, posterior fossa tumors are more common Most childhood brain tumors can be divided into two categories according to the cell of origin Glial tumors, such as astrocytomas and ependymomas Nonglial tumors, such as medulloblastoma and other primitive neuroectodermal tumors Some tumors contain both glial and neural elements (eg, ganglioglioma) A group of less common CNS tumors does not fit into either category (ie, craniopharyngiomas, AT/RTs, germ cell tumors, choroid plexus tumors, and meningiomas) Astrocytoma Most common brain tumor of childhood Most are juvenile pilocytic astrocytoma found in the posterior fossa with a bland cellular morphology and few or no mitotic figures Low-grade astrocytomas are in many cases curable by complete surgical excision alone Medulloblastoma and related primitive neuroectodermal tumors Most common high-grade brain tumors Usually occur in the first decade of life, with a peak incidence between ages 5 and 10 years and a female-male ratio of 2.1:1.3 Tumors typically arise in the midline cerebellar vermis, with variable extension into the fourth ventricle Brainstem tumors Third in frequency of occurrence Often of astrocytic origin and are high grade +++ Clinical Findings +++ Symptoms and Signs ++ Clinical findings at presentation vary depending on the child's age and the tumor's location Children younger than 2 years more commonly have infratentorial tumors Presenting symptoms usually nonspecific and include vomiting, unsteadiness, lethargy, and irritability Signs may be surprisingly few or may include macrocephaly, ataxia, hyperreflexia, and cranial nerve palsies Papilledema is often absent Measuring head circumference and observing gait are essential in evaluating a child for possible brain tumor Eye findings and apparent visual disturbances such as difficulty tracking can occur in association with optic pathway tumors such as optic glioma Older children more commonly have supratentorial tumors Associated with headache, visual symptoms, seizures, and focal neurologic deficits Initial presenting features are often nonspecific School failure and personality changes are common Vaguely described visual disturbance is often present, but the child ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.