Brain Tumors in Children

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Diagnosing and Treating a Pediatric Brain Tumor

If your child has shown any symptoms that concern you, tell your pediatrician about them. The pediatrician will probably perform a basic neurological exam on your child, including:  

  • reflexes
  • muscle strength
  • eye and mouth movement
  • coordination
  • alertness


If the pediatrician finds any cause for concern, the child will probably have some imaging tests done to look for clues to the source of the symptoms. Those imaging tests typically include:

X-rays can produce images of bones and organs and provide a quick and noninvasive glimpse into the body.

Magnetic resonance imaging (MRI) and computerized tomography (CT) scans produce detailed images of the brain and spine and allow doctors to detect the presence of a tumor. They are much more detailed than x-rays. Both of these tests are noninvasive, but they do require time in a scanner to produce tiny slices of images that are then combined into three-dimensional pictures. Sometimes the child will need a special contrast agent in advance to increase the visibility of any abnormality found.

After the imaging tests, a surgical biopsy may be performed to help confirm a diagnosis if it appears that a tumor may be present. In this procedure, a neurosurgeon extracts a small sample of abnormal cells to test in a pathology laboratory. Depending on the location and type of tumor, a biopsy is not always possible. Often, if a tumor  is large or causing pressure on part of the brain, the neurosurgeon will advise removing the entire tumor and performing a biopsy as part of that larger procedure.

An accurate diagnosis can be difficult, but pinpointing the exact type of tumor a child has  helps the medical team create the most effective treatment plan.  For more information about diagnosing specific pediatric brain tumors, see our index on the Children’s Brain Tumor Program page.

Once the tumor has been identified, your child’s treatment plan may include:

Surgery
Surgery to remove a brain tumor (called resection) may be possible, depending on the location and type of tumor. A benign tumor can often be completely cured with resection surgery. Treatment of a malignant tumor may include surgery to remove as much of the tumor as possible. Since malignant tumors often intrude into healthy tissue, complete removal of all cancer cells may not possible, so the neurosurgeon will removes as much as possible without damaging nearby brain tissue and causing neurological damage.  (See Surgery for Pediatric Brain Tumors.)

Chemotherapy
The term chemotherapy is a general one that means the use of cancer-fighting medicines. It is given systemically (meaning to the whole body, not just to the site of the tumor) and may be a pill, an injection, or an IV drip. Chemotherapy may be used before surgery to help shrink a tumor, or as follow-up after surgery to kill off any cancer cells left behind.  The challenge with chemotherapy for brain tumors is that the brain has a defense mechanism called the blood-brain barrier that protects the brain against toxins in the blood stream. Chemotherapy drugs are usually not able to cross the blood-brain barrier to attack the tumor itself.  Researchers at the Children’s Brain Tumor Project are currently testing new drugs, new ways of delivering those drugs, and a combination of the two, as strategies for fighting pediatric brain tumors.

Radiation
Precisely targeted beams of radiation can be an alternative to surgery, or radiation therapy can be used to kill cancer cells left behind after surgery. For many pediatric cancers, radiation is the best treatment choice available, although it can have long-term side effects. Radiation treatment plans may include multiple sessions over weeks or even months. A pediatric radiation oncologist will work with the other brain tumor specialists managing your child’s care to be sure the treatment plan is the most effective option for your child.

Other options may include steroid treatment to reduce swelling, or anti-epileptic medication to control seizures. Some children require a shunt to help drain blocked cerebrospinal fluid (CSF) — the shut is surgically implanted and may need to be repositioned occasionally (a procedure called a shunt revision).  Physical or occupational therapy or other rehabilitation may help a child regain lost motor skills and muscle strength; speech, physical, and occupational therapists may be involved in the healthcare team.

Researchers are now investigating other treatments, including immunotherapy and gene therapy

Children who have been treated for a brain tumor will have ongoing follow-up visits to manage any effects of the treatments and to continue imaging to detect any regrowth of the tumor.

At Weill Cornell Brain and Spine Center, our pediatric neurosurgeons are highly skilled in the most advanced procedures for treating pediatric brain tumors. Our relationships with top hospitals, including NewYork/Presbyterian and Memorial Sloan-Kettering, allow our surgeons access to the very best facilities and specialists, as well as the most leading-edge research laboratories, to ensure that your child gets the very best treatment available.

For more information about treating specific pediatric brain tumors, see our index on the Children’s Brain Tumor Program page.

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Reviewed by Jeffrey Greenfield, M.D., Ph.D.
Last reviewed/last updated: January 2015
Illustration by Thom Graves, CMI