Pediatric Disorders: Viewpoint—Surgery

Abstract

The pediatric brain is different from the adult brain in many ways. Plasticity, myelination, and tolerance to radiation dosages vary greatly with age. Furthermore, pediatric disorders of the brain differ significantly from those in adults. Central nervous system tumors are the most common solid tumors in children and second most frequent of childhood malignancies after leukemia. Pathology of pediatric brain tumors vary by age, with the heterogeneity of these tumors attributed to their unique natural history, treatment options, and prognosis. Surgery and extent of resection plays a large role in the management of these tumors. Radiation therapy is used more cautiously given concerns about its effect on the developing brain and on patients with long life expectancies. A team approach is usually taken in the management of pediatric brain tumors and includes the pediatric neurosurgeon, neuro-oncologist, radiation oncologist, psychologist, and radiologist among others. In cases of low-grade tumors, surgical intervention is recommended to obtain a tissue sample for diagnosis and to maximally resect the tumor while limiting morbidity. However, surgical management may not be the best method of treatment for highly invasive, malignant tumors or benign tumors that may infiltrate the visual pathways of a child. Factors such as age, histology, and tumor location are generally considered in determining the appropriate treatment, though in certain incidences these factors may be weak predictors of outcome. This chapter will focus on the treatment of tumors and vascular malformations of the pediatric brain from a surgical perspective.