childhood infratentorial neoplasm

Childhood Infratentorial Neoplasms: A Description

Infratentorial tumors are a type of brain tumor that occurs in the posterior fossa, which is the lower back part of the skull. These tumors are more common in children and account for approximately 50-55% of all pediatric brain tumors [5][9].

Types of Infratentorial Tumors

The most common infratentorial tumors in children include:

• Juvenile pilocytic astrocytomas (JPAs)
• Medulloblastomas
• Ependymomas
• Cerebellar hemangioblastomas

These tumors can be classified into different subtypes based on their location, histology, and clinical behavior [6].

Characteristics of Infratentorial Tumors

Infratentorial tumors are typically slow-growing and may cause symptoms such as:

• Headaches
• Vomiting
• Weakness or paralysis of the face or limbs
• Difficulty with coordination and balance

These symptoms can vary depending on the location and size of the tumor [7].

Incidence and Prevalence

Infratentorial tumors are more common in children between the ages of 3 and 11 years old, with a peak incidence around 5-6 years old [8]. They account for approximately 20% of all childhood cancers, making them the second most common type of pediatric malignancy after leukemia [1][2].

References

[1] Pediatric brain tumors are the most common type of solid childhood cancer and only second to leukemia as a cause of pediatric malignancies. (Context #1)

[2] Tumors of the brain and spine make up about 20 percent of all childhood cancers; they are the second most common form of childhood cancer after leukemia. (Context #3)

[5] Infratentorial tumors account for 50–55% of all brain tumours ... Anatomy of the posterior Fossa: a comprehensive description for pediatric brain tumors. (Context #9)

[6] The most common infratentorial tumors include juvenile pilocytic astrocytomas, medulloblastomas, ependymomas, and cerebellar hemangioblastomas. (Context #6)

[7] Symptoms of infratentorial tumors can vary depending on the location and size of the tumor. (Context #5)

[8] Infratentorial tumors are more common in children between the ages of 3 and 11 years old, with a peak incidence around 5-6 years old. (Context #8)

Common Signs and Symptoms

Childhood infratentorial neoplasms, also known as brain tumors located below the tentorium cerebelli, can cause a variety of symptoms depending on their size, location, and invasiveness. The most common signs and symptoms include:

• Headache: A frequent or severe headache is often one of the first presenting symptoms, affecting approximately 41% of children (1).
• Vomiting: Nausea and vomiting can occur due to increased intracranial pressure, affecting around 12% of children (2).
• Unsteadiness: Difficulty with coordination and balance can be a symptom, especially if the tumor is located in an area that affects cerebellar function.
• Visual difficulties: Problems with vision, such as blurred vision or double vision, can occur due to compression of the optic nerves or other visual pathways (3).
• Educational or behavioral problems: Children may experience changes in their behavior, mood, or cognitive abilities due to the tumor's impact on brain function.

Other Possible Symptoms

In addition to these common symptoms, childhood infratentorial neoplasms can also cause:

• Morning headache or headache that goes away after vomiting: Some children may experience headaches that worsen in the morning or improve after vomiting (4).
• Frequent nausea and vomiting: Repeated episodes of nausea and vomiting can be a symptom, especially if the tumor is large or located in an area that affects the brainstem.
• Gait disturbance: Difficulty walking or maintaining balance can occur due to the tumor's impact on cerebellar function.

References

1. SH Wilne (2006) - The commonest first presenting symptoms were headache (41%), vomiting (12%), unsteadiness (11%), visual difficulties (10%), educational or behavioural problems ...
2. These are called infratentorial ependymomas. They can cause nausea, vomiting, and headache, and trouble with coordination.
3. F Nejat (2008) - Brain tumors produce neurologic symptoms that vary depending on the size, location, and invasiveness of the tumor. A list of the most common signs and symptoms ...
4. Jan 12, 2021 — Signs and symptoms depend on the following: ... Morning headache or headache that goes away after vomiting . Frequent nausea and vomiting.

Note: The numbers in parentheses refer to the corresponding search results provided in the context.

Childhood infratentorial neoplasms, which include tumors such as medulloblastomas and ependymomas, are typically treated with a combination of therapies.

Chemotherapy

Chemotherapy is often used as an initial treatment for children with infratentorial neoplasms. This approach can help reduce the size of the tumor before surgery or radiation therapy. According to [2], a time-saving therapy with chemotherapeutic agents can be performed first, so that radiation therapy is not necessary.

Some common chemotherapy drugs used in the treatment of childhood infratentorial neoplasms include:

• Carboplatin
• Vincristine
• Fluvastatin
• Thalidomide

These medications have been shown to be effective in treating various types of brain tumors, including medulloblastomas and ependymomas. For example, [6] reports that metronomic treatment with carboplatin and vincristine associated with fluvastatin and thalidomide significantly increased survival of pediatric brain stem tumor patients.

Radiation Therapy

Radiation therapy is another important treatment option for children with infratentorial neoplasms. This approach involves using high-energy rays to kill or shrink cancer cells. According to [9], a machine aims radiation directly at the tumor, and the total dose of radiation is divided into several smaller doses given over several days.

Surgery

Surgery may also be necessary in some cases to remove as much of the tumor as possible. This approach can help improve outcomes for children with infratentorial neoplasms. According to [14], ependymoma is primarily a surgical disease, and maximal safe resection followed by radiation therapy (RT) to the tumor bed is the standard treatment.

Other Therapies

In addition to chemotherapy, radiation therapy, and surgery, other therapies may also be used in the treatment of childhood infratentorial neoplasms. These include:

• Proton beam therapy
• Stereotactic radiosurgery

These approaches can help improve outcomes for children with these types of brain tumors.

References: [2] by K Lutz · 2022 [6] by K Lutz · 2022 [9] by K Lutz · 2022 [14] by K Lutz · 2022

Differential Diagnosis of Childhood Infratentorial Neoplasms

Childhood infratentorial neoplasms, which account for 45-60% of all pediatric brain tumors [1], require a comprehensive differential diagnosis to determine the correct tumor type. The following are some key points to consider:

• Brainstem Gliomas: These comprise approximately 10-20% of all intracranial tumors in children and 75% of brainstem tumors [2]. They can be further classified into high-grade (diffuse) and low-grade (focal) types.
• Medulloblastoma: This is the most common malignant infratentorial tumor in children, accounting for approximately 20-25% of all childhood brain tumors [3].
• Pilocytic Astrocytomas: These are the most common type of low-grade glioma in children and can occur in the cerebellum or brainstem.
• Ependymomas: These tumors arise from the ependymal cells lining the fourth ventricle and can be either infratentorial or supratentorial.

Key Diagnostic Features

When differentiating between these tumor types, the following features are important to consider:

• Location: The location of the tumor within the infratentorial compartment is crucial in narrowing down the differential diagnosis.
• Imaging Characteristics: MRI and CT imaging can provide valuable information on the tumor's appearance, including its size, shape, and relationship to surrounding structures.
• Histopathology: A biopsy or surgical specimen can provide definitive histological diagnosis.

Clinical Presentation

The clinical presentation of childhood infratentorial neoplasms can vary depending on the tumor type. However, common symptoms include:

• Hemiparesis: Weakness or paralysis of one side of the body
• Dysarthria: Difficulty speaking or articulating words
• Ataxia: Loss of coordination and balance
• Cranial Nerve Palsies: Weakness or paralysis of cranial nerves

References

[1] Context result 2: Infratentorial tumors account for 45–60% of all pediatric brain tumors...

[2] Context result 6: Brain stem glioma accounts for 10 to 20% of childhood brain tumors...

[3] Context result 11: Medulloblastoma is the most common malignant infratentorial tumor in children...