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So a brain tumor is an abnormal collection of cells in the brain.
And pediatric brain tumor is different from
an adult brain tumor just as kids are not little adults.
Pediatric brain tumor is different from adult tumors in size and
type and treatment.
And they are about 2,500 pediatric brain tumors diagnosed each year.
In fact pediatric brain tumors are the most common solid tumor in
children.
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There are different types of brain tumors.
There are benign and malignant brain tumors.
A benign tumor or a low-grade tumor behaves differently than a malignant
or high-grade tumor, sometimes called the brain cancer.
And there are multiple different subtypes of tumors.
Depending on where the tumor is and the age of the child and
the type of tumor, the symptoms and signs are different.
One of the most common presentations of the child with
the brain tumor is headache and vomiting.
And that's because the brain is inside the skull.
It's in a closed container and so there's no room for anything else.
As the tumor grows, it can compress the brain and
that can cause headache.
Particularly worrisome is morning headache.
Because our breathing patterns change in sleep and there's
increased blood flow to the brain and that can cause morning headache.
That can be a red flag.
But many kids have headaches.
And most of the time, that's not related to a brain tumor.
Just as many of these symptoms are not related to a brain tumor, but
the kind of symptoms and signs that we look for
are changes in vision, loss of vision or double vision.
Seizures, irritation to the brain can cause seizures.
Behavior and affect changes can happen.
If the tumor is near the motor cortex, there can be weakness.
If it's near the sensory area, we can have numbness or tingling.
If it's near the language area, there can be speech difficulties.
If it's in the base of the brain, sometimes gait difficulties.
It can be very different, but
those are the kind of things that kids with brain tumors present with.
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Well, in the modern era now, we have the MRI, a magnetic resonance image
scan, and that's a wonderful tool because there is no radiation and
we can see with great precision.
The field of neurosurgery actually began here at Johns Hopkins over
a hundreds year ago when there was no imaging at all.
And the diagnosis had to be made on the basis of the history and
the physical exam.
But now, we had a beautiful test with really no risk that
can show us where the tumor is, what it looks like.
And we can be pretty accurate, not 100%, but
pretty accurate in diagnosing the type of tumor and
give some information about the prognosis.
It's not really until surgery though that we'll know what we're
dealing with.
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There are many different types of brain tumors.
And when a child has a brain tumor,
it's something that turns the entire family upside down.
This is a life-changing event.
And so, you want to be at a major medical center that has
a multidisciplinary team.
At Hopkins, we have a brain tumor group that meets weekly.
It consists of neurosurgeons, neuroradiologists, neurologists,
neuro-oncologists, tumor specialists, radiation specialists.
A multidisciplinary team to decide the best way to diagnose and
treat the tumor.
And in most cases, the tumor requires surgery.
And the purpose of surgery is one, to make a diagnosis and
then usually two, to try to remove as much as we safely can.
And then depending on the type of tumor, we go further.
Sometimes, surgery alone is all that's needed and sometimes adjuvant
or further therapy is needed, chemotherapy or radiation therapy.
And we decide that with a multidisciplinary team.
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One of the more exciting areas in the surgery of brain tumors is
the field of minimally invasive neurosurgery, which is a technique
that we use that employs endoscopes or small tubes and
miniaturized instruments to work through tiny exposures in the skull,
dime-sized openings, so that we can get deep in the brain and
diagnose and remove selected brain tumors.
Endoscopes are the same thing that the general surgeons use as
laparoscopes in the abdomen to take care of the gall bladder and
the appendix.
And it's particularly appealing to be able to use small
endoscopes in the brain.
Because when we're working with such a critical structure as the brain,
we wanna minimize the manipulation of the brain and
by doing that we can maximize the recovery.
In some ways,
it's a science fiction because it brings the surgeon to the pathology.
It allows us to get, it's like taking a fantastic voyage.
It shrinks us down, we bring the operator to the pathology and we can
work through tiny exposure to get the same result with less trauma.
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I think it's never a bad idea to get a second opinion.
Particularly, when you are dealing with a condition
where the stakes are so high.
And in most major medical centers,
there are tumor teams that will go over the case.
But it's never a bad idea
to have another set of eyes to look at a problem.
And we have a second opinion program at Hopkins.
And many times, we'll agree with the plan that is outlined
by the original institution.
But sometimes we see things differently and
may be able to make other suggestions.
And occasionally we'll see a case which was diagnosed
to be a malignant inoperable brain tumor, even without
any further intervention, and we'll say, it looks a little different.
Maybe we should take a look.
And occasionally, we'll find a case that was thought to be malignant and
inoperable that ends up being benign.
That makes a lifetime of difference for the patient and for the family.
Doesn't happen all the time, but if it happens once,
that's the value of a second opinion.
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The prognosis for a child with a brain tumor is different depending
on the age of the child, the type and grade of the tumor,
the location of the tumor and a number of factors.
But the important thing, I think,
is to recognize that a brain tumor in a child is a life-changing event.
It changes the life of the child and the entire family.
And we're not just treating the tumor.
We're treating the patient.
And so it's important, I think, to be cared for
by a multidisciplinary team that gives the best available technology
but the best available healing for the entire family.
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