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PubMed1975

Adjuvant immunotherapy for malignant brain tumors in infants and children.

Immune deficiency of immunocompetent cells or of humoral factors are essential causes of tumor growth. The authors have investigated the transfer of immunocompetent cells - allogeneic bone marrow cell transfusion and white blood cell intracranial infusion - for the treatment of 11 malignant gliomas in infants and children as an adjuvant to surgery, radiation and/or chemotherapy. Ten cases, from 3 months to 11 years, received bone marrow cell transfusion. Two medulloblastomas and 3 pontine gliomas are dead. Five cases are alive and well 37-65 months following surgery. Among these two posterior fossa neoplasms, a medulloblastoma and a glioblastoma have survived 46 and 65 months, respectively. One cerebral glioblastoma received allogeneic white blood cells infused locally into the tumor bed: it recurred 1 year following surgery, chemotherapy, and immunotherapy. Cytolysis of the tumor cells by sensitized lymphoid cells were demonstrated in this case. The role of immunotherapy should be limited at the present time to adjuvant therapy until its effect on tumor growth is statistically confirmed. The results so far are promising, and improvement of the immunological approach in treating malignant brain tumors is under way.

Bone Marrow Cells↗
PubMed1976

Role of computerized axial tomography in diagnosis and treatment of common neurosurgical problems of infancy and childhood.

Computerized axial tomography (CAT) is a new, highly accurate technique for studying the skull and intracranial contents. It is rapid enough to be utilized in acute emergencies and safe enough to be utilized for routine serial followups and evaluation of outpatients with equivocal findings. Because CAT can delineate the ventricular system without need for contrast agent, can distinguish clearly between hematoma and edema and can differentiate cystic from solid tumors, it finds wide application in the evaluation of neurological disease.

Brain Diseases↗
PubMed1981

Hemorrhagic brain tumors in pediatric patients.

In an unselected pediatric series of 113 newly tissue verified intracranial tumors, intracranial hemorrhage was the initial presentation in 10% of the cases. Review of all cases of subarachnoid hemorrhage admitted to Children's Hospital of Philadelphia during the period of 1976--1979 revealed that intracranial tumors were present in 15%. The largest hemorrhagic pathological group was medulloblastoma-primitive neuroectodermal tumors. No particular age predominance was noted. The high incidence of intracranial tumor hemorrhage in this series of pediatric patients suggests that this may be a more common presentation than previously reported.

Adolescent↗
PubMed1984

Re-operation for recurrent brain tumors in children.

In order to determine the efficacy of re-operating on recurrent brain tumors, we did a retrospective analysis of 39 children who underwent such surgery between 1975 and the present. A total of 52 procedures was performed for recurrence of both benign and malignant tumors. 9 patients are neurologically normal and 12 are independent but left with some sort of neurologic deficit for an average of 31 months and 32 months, respectively, postoperatively. 1 child presented severely handicapped and remains so 18 months after his most recent surgery. 17 patients died. 11 improved after re-operation and lived an average of 12 months. 4 were unimproved with an average survival of 10 months. There were 2 surgical deaths for an operative mortality of 4%. We feel that re-operation is a useful therapy for both benign and malignant recurrent brain tumors, and prolongs both the quantity and quality of life in appropriately selected patients.

Astrocytoma↗
PubMedDate not supplied

Treatment of brain tumors in babies and very young children.

Approximately 13% of brain tumors in childhood occur in children less than 2 years of age. Although the survivals of older children with certain forms of brain tumors have increased over the past 20 years, this treatment has been least effective in very young children with brain tumors. These poor survival rates may be due in part to the highly malignant nature of the neoplasms; the delay in diagnosis because of low index of suspicion; the large bulk of tumor found at presentation, and the reduction in radiation dosage to the central nervous system. Since standard treatment has produced both poor results and severe neurotoxicity, new approaches have been sought. A conservative approach is recommended in some children with optic gliomas and low-grade supratentorial astrocytomas. Radiation is deferred until the child reaches 3-4 years of age when he can better tolerate its effects on the CNS. Current therapy of malignant brain tumors of infancy is not only toxic, but inadequate. There are several centers which currently use postoperative chemotherapy and delayed radiation. Early results have been encouraging and neurotoxicity has been low.

Adolescent↗
PubMed1987

Current management of low-grade astrocytomas of childhood.

Astrocytomas are the most frequently encountered brain neoplasms in the pediatric age group. Current management strategies consist of surgery, radiation therapy, chemotherapy and immunotherapy, although the optimal treatment is yet to be defined. It is hoped that new treatment modalities, and reassessment of current regimens will improve outcome, better in terms of survival and quality of life.

Astrocytoma↗
PubMed1996

Epidemiological study of primary intracranial tumors in childhood. A population-based survey in Kumamoto Prefecture, Japan.

Between 1989 and 1995, we diagnosed primary intracranial neoplasms in 79 children younger than 15 years. All of them belonged to a well-defined population residing in Kumamoto Prefecture, Japan. Of the tumors, 64 (81.0%) were confirmed microscopically. The age-adjusted annual incidence rate was 34.3 cases per million child population. There was a marked difference in the incidence rate between boys (47.1) and girls (22.05). The age-specific annual incidence per million was 24.3 cases for the 0- to 4-year age group, 46.7 for the 4- to 9-year age group and 30.8 for the 10- to 14-year age group. The highest incidence rate was seen in 5- to 14-year-old boys (53.5), the lowest in 10- to 14-year-old girls (7.1). The most common tumors were astrocytomas (41.8%), with an incidence of 14.52 per million, followed by germ cell tumors (15.1%), with an incidence of 6.24 per million, craniopharyngiomas (15.1%), incidence 5.25 per million, ependymomas (6.3%), incidence 2.19 per million, and medulloblastomas (6.2%), incidence 2.19 per million. The distribution of tumor types varied with patient age at the time of diagnosis. Although no germ cell tumors were encountered in the 0- to 4-year age group, in the 10- to 14-year age group, they comprised about one third of all tumors. In contrast, white craniopharyngiomas were rare in the 10- to 14-year age group, they made up more than 22% in the 0- to 4-year age group. In this survey of Japanese children, we found a higher incidence of primary intracranial tumors, especially germ cell tumors and craniopharyngiomas, and a lower incidence of medulloblastomas compared to the incidence reported for Western countries.

Adolescent↗
PubMed1997

Multiple cavernous angiomas after high-dose whole-brain radiation therapy.

Modern neuroimaging techniques have led to increased identification of angiographically occult cerebral angiomatous malformations. Cavernous angiomas or cavernomas account for approximately 16% of all cerebrovascular malformations. Little is reported about the etiology or risk for acquiring these lesions. This report suggests a possible association between acquired intracranial vascular malformations and long-term survivors after craniospinal external beam radiation therapy indicating that greater understanding of the cerebral vascular system's response to injury may provide insight into the evolution and progression of these lesions.

Adolescent↗
PubMedDate not supplied

Facial nerve repair in cerebellopontine angle surgery.

Facial nerve continuity was restored during cerebellopontine angle tumor removal in nine cases. The distal facial nerve was rerouted from the stylomastoid foramen into the cerebellopontine angle. Direct suture was accomplished in seven cases while two required interposition of a greater auricular nerve graft. There was excellent return of facial function in eight of the nine cases. Overall results are superior to nerve substitution techniques. The facial nerve should be inspected for continuity following tumor removal. If one is not certain the nerve is intact, the proximal facial stump should be identified at the brain stem and facial nerve continuity reestablished. A nerve substitution procedure should be resorted to a later time only when the proximal facial stump is not identifiable.

Adult↗
PubMedDate not supplied

Rare tumors of the cerebellopontine angle.

IN a series of 1,354 cerebellopontine angle tumors treated at the Otologic Medical Group, approximately 10% were lesions other than acoustic neurinomas. Of the non-acoustic tumors, the majority were meningiomas, primary cholesteatomas, and neurinomas of other cranial nerves in the posterior fossa. Twenty-five other lesions were encountered; these rare tumors are the subject of this study. The benign tumors resemble acoustic neurinomas in appearance and in the method of treatment. Malignant tumors are characterized by rapid development of symptoms and are difficult to treat because of invasion of vital structures in the area.

Arachnoid↗
PubMed1988

Intracranial and intratemporal meningiomas with primary otologic symptoms.

Intratemporal extensions of cerebellopontine angle (CPA) meningiomas are unusual and primary intratympanic meningiomas are extremely rare. The initial symptoms of both types are otologic. The presenting symptoms of even large meningiomas of the cerebellopontine angle can also be otologic. In this article we report the clinical features, diagnosis, and management of five CPA meningiomas, three combined intratemporal and CPA meningiomas, and one primary intratympanic meningioma.

Adolescent↗
PubMed1998

Intracranial tumors mimicking benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo is a common type of vertigo seen by the otolaryngologist; however, intracranial tumors can mimic benign paroxysmal positional vertigo in their presentation. A review of patients seen in the Department of Otolaryngology at The Ohio State University between July 1992 and August 1996 identified five patients with intracranial pathologic conditions mimicking benign paroxysmal positional vertigo. These patients were first seen with episodic vertigo associated with positional change. Failure of the symptoms to respond to the particle repositioning maneuver or the finding of associated auditory or neurologic symptoms prompted further evaluation by magnetic resonance imaging of the brain, which revealed intracranial pathologic conditions including two meningiomas, a vestibular schwannoma, a glioma, and a lipoma. These findings suggest that patients seen with symptoms like those of benign paroxysmal positional vertigo who do not show improvement after undergoing the particle repositioning maneuver or those who describe associated auditory or neurologic symptoms should have magnetic resonance imaging done to rule out intracranial pathologic conditions. Additionally, benign paroxysmal positional vertigo and intracranial tumors may coexist.

Adult↗