Posterior fossa tumors in infants and neonates.
BACKGROUND
Management of posterior fossa tumors in infants and neonates is challenging. The characteristics of the young babies make surgery very difficult, sometimes precluding a safe complete removal.


METHODS
A review of the literature was undertaken to examine the incidence, histology, surgical aspects, and prognosis of posterior fossa tumors in the first year of life. Therapeutical strategies of the most frequent tumor types are also discussed in detail.


RESULTS
Histology is dominated by tumors with aggressive behavior, such as medulloblastomas, atypical teratoid/rhabdoid tumors, and anaplastic ependymomas. The most important surgical considerations in small children are the small circulating blood volume; the poor thermoregulation; and incomplete maturation of the brain, of the skull, and of the soft tissue. Treatment toxicity is inversely related to the age of the patients. Radiation therapy is usually considered as contraindicated in young children, with few exceptions. Proton therapy is a promising tool, but access to this kind of treatment is still limited. The therapeutic limitations of irradiation render resection of this tumor and adjuvant chemotherapy often the only therapeutic strategy in many cases.


CONCLUSIONS
The overall prognosis remains dismal because of the prevalent aggressive histologies, the surgical challenges, and the limitations of adjuvant treatment. Nevertheless, the impressive improvements in anesthesiology and surgical techniques allow, in the vast majority of the cases, complete removal of the lesions with minor sequelae in high-volume referral pediatric centers.
Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Pietro
P
Spennato
Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Giancarlo
G
Nicosia
Division of Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Lucia
L
Quaglietta
Division of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Vittoria
V
Donofrio
Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Giuseppe
G
Mirone
Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Giuliana
G
Di Martino
Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Elia
E
Guadagno
Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Maria Laura
ML
del Basso de Caro
Division of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Daniele
D
Cascone
Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy. giuseppe.cinalli@gmail.com.
Giuseppe
G
Cinalli
D003388:Cranial Fossa, Posterior / Q000473:pathology* / Q000601:surgery; D019468:Disease Management; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015192:Infratentorial Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male
Atypical teratoid rhabdoid tumor; Ependymoma; Infants; Medulloblastoma; Neonates; Pilocytic astrocytoma; Pilomyxoid astrocytoma; Posterior fossa tumors