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Published in: Child's Nervous System 10/2015

01-10-2015 | Special Annual Issue

Posterior fossa tumors in infants and neonates

Authors: Pietro Spennato, Giancarlo Nicosia, Lucia Quaglietta, Vittoria Donofrio, Giuseppe Mirone, Giuliana Di Martino, Elia Guadagno, Maria Laura del Basso de Caro, Daniele Cascone, Giuseppe Cinalli

Published in: Child's Nervous System | Issue 10/2015

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Abstract

Introduction

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.
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Metadata
Title
Posterior fossa tumors in infants and neonates
Authors
Pietro Spennato
Giancarlo Nicosia
Lucia Quaglietta
Vittoria Donofrio
Giuseppe Mirone
Giuliana Di Martino
Elia Guadagno
Maria Laura del Basso de Caro
Daniele Cascone
Giuseppe Cinalli
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 10/2015
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-015-2783-6

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