Diagnosis and treatment of subtentorial brain tumors in children at the beginning of the XXI century

Abstract

Cerebral tumors are among the most menacing pathologies occurring in children. Of all the cerebral tumors, posterior cranial fossa tumors have been most widespread in children. The review of literature provides a detailed description of clinical pattern. The sources related about earlier occurrence of non-focal symptoms, rather than focal signs: lack of energy, nausea, vomiting and headache. The authors provided detailed description of cerebellum damage in case of tumors, and split the symptoms of the hemisphere and vermis injuries as ataxy and typical cerebellar gait are common to spot the malignant process in the vermis, whereas dyssynergia and hypomyotonia occur in case of hemisphere damage. The clinical picture of hydrocephalus in tumor pathology of posterior cranial fossa is discussed: rapidly growing child head circumference, separation of cranial sutures, bulging of fontanelle, child restless behavior, and other signs. The need for CT and MRI was substantiated as the most important diagnostic techniques; the benefits of each were also stated. Discussion was given to the clinical pattern of hydrocephalus in tumor pathology of the posterior cranial fossa, and the authors put special emphasis on the significance of presurgical correction of hydrocephalus. The authors mentioned the use of a neuronavigation system during surgical intervention and characterized the major accesses (access via the median aperture, transvermial, telovelar access) and methods of craniotomy, indications for resection and osteoplastic trepanation. This article discussed the basic principles of radio and chemotherapy used to achieve a sustained remission, approximate treatment patterns for various posterior cranial fossa tumors are described. In addition, the authors mentioned the need for MRI with contrast agent each 3 months, and subsequent visits to the specialist in oncology.