BRAIN AND SPINAL CORD TUMORS

What are the symptoms of a tumor in the brain or spinal cord?

Tumors of the central nervous system constitute the second most common cancer of childhood. Tumors can occur in any portion of the brain and spinal cord and can be benign or malignant. If the tumor develops in the brain, children usually develop headache, rapid head growth (in infants), and nausea with or without vomiting. If the tumor develops in the spinal cord, children can develop numbness, weakness, incontinence, or difficulty walking.

How is a tumor in the brain or spinal cord evaluated?

When a tumor is suspected, the first step is neuroimaging. Usually MRI scanning with and without a contrast agent is the preferred study. The contrast agent is a drug given intravenously which can provide additional detail of the tumor and surrounding nervous system structures. Once the MRI is completed, treatment decisions are made. Usually a surgical biopsy or resection is performed. Pathologic evaluation of the tumor directs subsequent treatment choices, which include chemotherapy and/or radiation therapy.

What is the surgical treatment of a tumor in the brain or spinal cord?

For most pediatric brain tumors, the extent of tumor resection is critical. A greater than 90% removal correlates with improved long-term survival. To enhance the safety of tumor resection, functional mapping techniques are utilized. These include magnetoencephalography (MEG) and intraoperative corticography. Both techniques can identity areas of brain critical to motor, sensation, and speech, so that these can be avoided during tumor resection. In addition, image guided systems allow computer guided resection of tumors.

What happens after surgery for a tumor in the brain or spinal cord?

Treatment following surgery is directed by the pathologic diagnosis, the location of the tumor, and the extent of resection. The care is conducted by a multidisciplinary team consisting of a neurooncologist, radiation oncologist, neurologist, and neurosurgeon. Treatment may be as simple as observing the tumor with serial MRI scans or as complicated as chemotherapy with radiation therapy. Coordinated care and long term surveillance should be part of every patient's care.

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