BACKGROUND- Over the course of a career, the neurologist and child neurologist will diagnose and participate in treating at least several children with brain tumors. The proliferation of neuro-oncology centers in larger medical centers lends to the referral of patients to those centers, sometimes a distance from home, where patients can receive state-of-the-art care. However, there continues to be a role for the non-subspecialist neurologist in caring for children with brain tumors, both during and after therapy is completed. The families will often look to a neurologist who does not have an affiliation with the larger medical centers for an opinion regarding treatment options. During treatment, the neurologist will often monitor anticonvulsant therapy; after treatment, the community neurologist will often provide care to that child for many years.
REVIEW SUMMARY- New surgical techniques have made aggressive attempts at tumor removal safer than in the past. In some instances, less invasive surgical approaches will result in the same result, without the need for a craniotomy or ventriculoperitoneal shunt. Improvements in radiotherapy techniques will allow for increasingly conformal approaches to treating only the volume of tumor and brain intended, which will hopefully result in less cognitive toxicity. New medications for treating the most common malignant brain tumor in children, the medulloblastoma, have resulted in greatly improved survival and will allow for the radiotherapy close to be reduced to a more tolerable close. Aggressive approaches to delivering high-dose chemotherapy are still controversial, but the initial data in infants suggest that cognitive function is spared if radiotherapy can be delayed, although there is significant early treatment toxicity, as well as delayed second malignancies.
CONCLUSION- There have been a number of advances in caring for children with brain tumors. Complete surgical excision without complication remains the major problem encountered for the child a low-grade neoplasm. For most high-grade tumors, disease control without unacceptable toxicity remains the goal for the future. In this article, I review recent advances in terms of pathogenesis and new concepts in pathology, as well as advances in brain tumor management.