Congenital tumors of the central nervous system: the MCH experience.
BACKGROUND
Congenital brain tumors in the younger pediatric population are rare lesions that are histologically distinct from those in the older pediatric population. Malignant histology is common, with persistently poor outcomes despite accessible neuroimaging and evolving adjuvant therapy. There remains scant literature about the natural history of these patients because of rarity and varied institutional experiences.


METHODS
A retrospective review was performed of congenital brain tumor patients surgically treated at the Montreal Children's Hospital (MCH) over a 22-year period. Patients presenting in the first year of life were evaluated for demographic information, presenting symptoms, lesion location, and management. Analysis was by median rank test and chi(2) statistics.


RESULTS
13 cases of congenital brain tumors were identified: 5 supratentorial and 8 infratentorial. Median age (p = 0.93) and gender (p = 0.57) did not differ by location, and predominant histologies were choroid plexus papilloma and primitive neuroectodermal tumor. Seizure activity was exclusive to supratentorial lesions (40%, p = 0.03), with hypotonia observed only among infratentorial lesions (50%, p = 0.02). There was equal incidence of hydrocephalus (69%, p = 0.57) and increasing head circumference (38%, p = 0.27) by lesion location. Supratentorial lesions were treated by total resection (n = 3), subtotal resection (n = 1), and biopsy (n = 1). Infratentorial lesions were treated by total resection (n = 1), subtotal resection (n = 2), biopsy (n = 1), no operation (n = 2), and decompressive laminectomy for two spinal lesions.


CONCLUSIONS
Congenital brain tumor patients represent fewer than 2% of patients treated at MCH. An evolving understanding of management objectives for these lesions requires understanding institutional experiences. Patients with supratentorial lesions frequently present with seizures, hydrocephalus, and macrocrania, and more frequently underwent total resection at surgery.
Shamji
Mohammed F
MF
Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada. shamji@aya.yale.edu
Vassilyadi
Michael
M
Lam
Cornelius H
CH
Montes
José L
JL
Farmer
Jean-Pierre
JP
D001254:Astrocytoma / Q000151:congenital / Q000401:mortality / Q000601:surgery; D001932:Brain Neoplasms / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000151:congenital / Q000401:mortality / Q000601:surgery; D019299:Decompression, Surgical / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007796:Laminectomy / Q000706:statistics & numerical data; D008297:Male; D008527:Medulloblastoma / Q000151:congenital / Q000401:mortality / Q000601:surgery; D018242:Neuroectodermal Tumors, Primitive / Q000151:congenital / Q000401:mortality / Q000601:surgery; D009864:Ontario / Q000453:epidemiology; D020288:Papilloma, Choroid Plexus / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018335:Rhabdoid Tumor / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D013125:Spinal Neoplasms / Q000151:congenital / Q000401:mortality / Q000601:surgery*