Medulloblastoma

Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more information.

Cerebellar astrocytoma

Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for more information.

Ependymoma

Refer to the PDQ summary on Childhood Ependymoma Treatment for more information.

Brain stem glioma

Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.

Cerebral astrocytoma

Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more information.

Craniopharyngioma

These are symptomatic benign tumors arising from remnants of Rathke’s pouch. There is no generally accepted staging system and metastasis is rare.[1,2,3,4]

Central nervous system germ cell tumor

Germ cell brain tumors usually arise in the pineal or suprasellar regions. Histologic subtypes include teratoma (both mature and immature), germinoma, choriocarcinomas, and nongerminomatous germ cell tumors (i.e., embryonal cell carcinoma, yolk cell or endodermal sinus tumor, and mixed germ cell tumors). These tumors have a propensity for subarachnoid spread. Every patient with a germinoma or malignant germ cell tumor should be evaluated with diagnostic imaging of the spinal cord and whole brain. The best method for evaluating spinal cord subarachnoid metastasis is MRI with gadolinium enhancement. Cerebrospinal fluid should be examined cytologically and levels of alpha-fetoprotein (AFP), and human chorionic gonadotropin (HCG) determined. AFP and/or HCG may be elevated in the serum of such patients. Prognosis is related to histology; patients with pure germinoma have a more favorable outcome than those with nongerminomatous germ cell tumors (nongerminomas).[5,6]

Pineal parenchymal tumors

Pineoblastoma, pineocytoma. (Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma Treatment for more information.)

Supratentorial primitive neuroectodermal tumor

PNETand cerebral neuroblastoma. (Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma Treatment for more information.)

Visual pathway and hypothalamic glioma

Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.

Spinal cord tumors

There is no uniformly accepted staging system for childhood primary spinal cord tumors. These tumors are classified based on their location within the spinal cord and histology. Low-grade spinal cord tumors rarely disseminate elsewhere in the nervous system; however, higher grade tumors may disseminate.[7,8] Despite this, because of the location of the tumor and concerns over causing further neurologic deterioration by cerebrospinal fluid attainment, routine lumbar spinal punctures are not indicated in the evaluation of a child with a spinal cord tumor. For high-grade glial spinal cord tumors, and possibly lower grade tumors and ependymomas, neuroimaging of the entire neuroaxis (brain and entire spine) is indicated at the time of diagnosis for determination of extent of disease.

References:

1. Lapras C, Patet JD, Mottolese C, et al.: Craniopharyngiomas in childhood: analysis of 42 cases. Prog Exp Tumor Res 30: 350-8, 1987.
2. Habrand JL, Ganry O, Couanet D, et al.: The role of radiation therapy in the management of craniopharyngioma: a 25-year experience and review of the literature. Int J Radiat Oncol Biol Phys 44 (2): 255-63, 1999.
3. Yasargil MG, Curcic M, Kis M, et al.: Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73 (1): 3-11, 1990.
4. Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46 (2): 291-302; discussion 302-5, 2000.
5. Matsutani M, Sano K, Takakura K, et al.: Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86 (3): 446-55, 1997.
6. Balmaceda C, Modak S, Finlay J: Central nervous system germ cell tumors. Semin Oncol 25 (2): 243-50, 1998.
7. Constantini S, Miller DC, Allen JC, et al.: Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93 (2 Suppl): 183-93, 2000.
8. Bouffet E, Pierre-Kahn A, Marchal JC, et al.: Prognostic factors in pediatric spinal cord astrocytoma. Cancer 83 (11): 2391-9, 1998.