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Posterior fossa tumors in infants and neonates

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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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Conflict of interest

All authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Pietro Spennato, Giancarlo Nicosia, Giuseppe Mirone, Giuliana Di Martino & Giuseppe Cinalli

  2. Division of Oncology, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Lucia Quaglietta

  3. Division of Pathology, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Vittoria Donofrio

  4. Division of Neuroradiology, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Daniele Cascone

  5. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    Elia Guadagno & Maria Laura del Basso de Caro

Authors
  1. Pietro Spennato
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  2. Giancarlo Nicosia
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  3. Lucia Quaglietta
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  4. Vittoria Donofrio
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  9. Daniele Cascone
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  10. Giuseppe Cinalli
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Corresponding author

Correspondence to Giuseppe Cinalli.

Additional information

This work is dedicated to the memory of Roberta Migliorati, M.D. (1955–2014), who dedicated her whole life to the care of children affected by brain tumors.

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Spennato, P., Nicosia, G., Quaglietta, L. et al. Posterior fossa tumors in infants and neonates. Childs Nerv Syst 31, 1751–1772 (2015). https://doi.org/10.1007/s00381-015-2783-6

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