It may take longer to recognize the symptoms of brain tumor in infants and children than it does in adults.
At Mayo Clinic in Rochester, Minn., once a tumor is suspected, efficient integration across pediatric oncology, neurology, neuroradiology, neurosurgery and neuropathology smoothes the diagnostic process. Collaborating in every aspect of pediatric care at Mayo Clinic's T. Denny Sanford Pediatric Center and the Eugenio Litta Children's Hospital, the medical team can typically arrive at a diagnosis over the course of several days, rather than weeks.
Children with brain tumors may have obvious neurologic signs, such as focal sensorimotor deficits or asymmetric motor skills, indicative of a tumor. Other readily recognized signs include:
Often, however, the symptoms are less specific. For example, persistent vomiting over the course of two to three weeks without other gastrointestinal tract or respiratory tract signs or fever might be a response to pressure within the brain from a tumor. Other nonspecific symptoms include:
In older children, the signs may include head tilt and eye deviation.
All initial work-ups for new brain tumor patients are managed by a designated pediatric neurologist who coordinates consults with any of Mayo's nine other pediatric neurologists, a pediatric oncologist, and often with a radiation oncologist and pediatric neurosurgeon.
Anesthesiologists with special expertise in pediatrics sedate children for imaging studies, paying particular attention to each patient's age and severity of illness. Tests for brain tumors in children at Mayo may include CT scan, MRI, MR spectroscopy, and, in some cases, PET scans.
If seizures are present, pediatric epilepsy specialists help determine if the tumor alone is causing the seizures. Mayo Clinic has extensive experience in 24-hour video monitoring for epilepsy before surgery. Pediatric neuropsychologists provide behavioral and developmental testing. Specialists in pediatric endocrinology and genetics are also available as needed.
Surgical resection is considered the best treatment for most childhood brain tumors. Because chemotherapy and radiation therapy pose risks for the developing brain, removing as much of the tumor as possible is critical. Nicholas Wetjen, M.D., a pediatric neurosurgeon, notes, "Too often we see patients in whom the tumor has been incompletely resected or an inadequate tissue sample has been collected for biopsy. Then we are dealing with both the adverse effects of surgery and the need to redo the surgery."
At Mayo, an initial biopsy for pathology testing can often be conducted during the surgical procedure. Cynthia Wetmore, M.D., Ph.D., a pediatric neuro-oncologist, points out, "Even if the tumor is completely resectable, adjunct chemotherapy or radiation therapy often improves long-term survival, except in children less than 3 years old, for whom radiation is not recommended."
Among the many research initiatives in the pediatric neuro-oncology program at Mayo:
Mayo offers state-of-the-art neurosurgical techniques, including:
Mayo neurosurgeons have extensive experience in tumor resection in both the adult and pediatric practice. Experience matters; a recent study found that it is a major factor affecting pediatric brain tumor surgical outcomes.
Unlike adults, 95 percent of children who have chemotherapy in the United States are treated through protocols specified by the National Cancer Institute (NCI). Most clinicians involved in the direct management of pediatric brain tumors at Mayo Clinic in Minnesota are members of the Children's Oncology Group (COG) through the NCI. All postsurgical therapy is directed by a member of COG.
Mayo Clinic's T. Denny Sanford Pediatric Center serves more than 45,000 children a year. From its nature-inspired theme to its specialized furniture, restrooms and drinking fountains, it is designed for children of all ages. It is a colorful, welcoming environment, but more importantly, it is staffed by pediatric experts from every specialty working together in a central location to coordinate care to the patient's best advantage.
Mayo Clinic's Eugenio Litta Children's Hospital is staffed by more than 150 physicians. Distinct from but located within Mayo's Saint Marys Hospital, patients have access to the expertise of Mayo's entire staff of physicians.
The facility includes playrooms for all ages and a teen lounge. Tutors are available from the Rochester Public School system for children absent from school for long periods of time. Physical therapists, speech-language pathologists, and other pediatric rehabilitation specialists work with patients during recovery.
A diagnosis of brain tumor affects the entire family. Social workers and child-life specialists support children and families before, during, and after surgery. The hospital has special family space with laundry, kitchen, and shower facilities. Pets are permitted to visit.
For patients who come from a distance, there is the Ronald McDonald House, located only blocks from the clinic and hospital. Supported by charitable contributions and available with a Mayo Clinic referral, it has 45 rooms at a minimum cost, accommodating up to five persons per room for as long as needed, be it six days or six months.
As Dr. Wetmore notes, "We have a commitment to our pediatric brain tumor patients and their families that extends from our breadth and depth of interdisciplinary expertise to our brain tumor research and our child-centered, state-of-the-art facilities."