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Surgical treatment of pediatric brain tumors

Article information

J Korean Med Assoc. 2012;55(5):438-446
Publication date (electronic) : 2012 May 16
doi : https://doi.org/10.5124/jkma.2012.55.5.438
Ji Hoon Phi, MD1,2, Kyu-Chang Wang, MD1, Seung-Ki Kim, MD1,2
1Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.
2Adolescent Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea.
Corresponding author: Seung-Ki Kim, nsthomas@snu.ac.kr
Received 2012 March 05; Accepted 2012 March 19.

Abstract

Brain tumors are the second most common form of cancer in the pediatric age group. Surgical treatment is the mainstay of therapy for many brain tumors and is usually the first treatment given to children with brain tumors. Pediatric brain tumors differ from those of adults in many aspects: histological diagnosis, immaturity of the pediatric central nervous system, and the vulnerability of children to blood loss during the operation. The completeness of surgery is strongly associated with the prognosis of afflicted children, whereas surgical morbidities can be life-time deficits and handicaps for the children. Therefore, practicing pediatric neurosurgeons should combine a thorough knowledge on neuroanatomy and pathophysiology with state-of-the-art surgical skills and experience to obtain the best results. They should also take time for reflecting on the difficulties encountered and complications arising during operations.

Keywords: Brain neoplasms; Child; Neurosurgery

Acknowledgement

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (no. 0520300).

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Copyright © 2012 Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Figure 1

Computed tomography scans of a 1-year-old girl who de-veloped a sudden collapse after a few days with projectile vomiting. (A) Ventricles are enlarged and cerebral sulci are invisible due to high intracranial pressure, even after the insertion of an extraventricular drainage (EVD) catheter. The tip of the EVD catheter is seen. (B) A huge tumor of low-density (arrow heads) fills the posterior fossa.

Figure 2

Figure 2

Surgical corridors and approaches to the 3rd ventricles.

Figure 3

Figure 3

The use of intraoperative ultrasonography for real-time identification of brain parenchymal lesions. (A) Application of the ultrasonography probe. (B) Ultrasonographic image of a cortical mass (arrow heads).

Figure 4

Figure 4

Magnetic resonance (MR) images and intraoperative photos of a 7-year-old boy with medulloblastoma. (A) Preoperative MR image shows a large contrast-enhancing mass in the 4th ventricle and obstructive hydrocephalus. (B) After removal of the bulk of the tumor, cerebral aqueduct is exposed above (arrow). (C) The tumor was complete removed and the 4th ventricular floor is well-visualized. (D) Immediate postoperative MR image demonstrates gross total resection of the tumor. Only a small amount of hemorrhage is observed in the surgical bed.