When a tumor is suspected, the first step is neuroimaging. Usually MRI scanning with and without a contrast agent is the preferred study. The contrast agent is a drug given intravenously which can provide additional detail of the tumor and surrounding nervous system structures. Once the MRI is completed, treatment decisions are made. Usually a surgical biopsy or resection is performed. Pathologic evaluation of the tumor directs subsequent treatment choices, which include chemotherapy and/or radiation therapy.
For most pediatric brain tumors, the extent of tumor resection is critical. A greater than 90% removal correlates with improved long-term survival. To enhance the safety of tumor resection, functional mapping techniques are utilized. These include magnetoencephalography (MEG) and intraoperative corticography. Both techniques can identify areas of brain critical to motor, sensation, and speech, so that these can be avoided during tumor resection. In addition, image guided systems allow computer guided resection of tumors.
With a family-centered approach, the team treats a variety of brain and spinal cord tumors, including:
Treatment following surgery is directed by the pathologic diagnosis, the location of the tumor, and the extent of resection. The care is conducted by a multidisciplinary team consisting of a neurooncologist, radiation oncologist, neurologist, and neurosurgeon. Treatment may be as simple as observing the tumor with serial MRI scans or as complicated as chemotherapy with radiation therapy. Coordinated care and long term surveillance should be part of every patient's care.
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