Intracranial tumors in infants

The prognosis in infants with brain tumors has historically been very poor. This study reviews 16 infants under the age of 12 months with brain tumors who presented to our institution between 1988 and 1999. The aim was to describe the clinical presentation, diagnosis, and management of these patients and to establish if newer diagnostic and treatment modalities have improved prognosis in terms of survival and neurocognitive outcome. Charts were reviewed retrospectively for age at diagnosis, time to diagnosis, presenting features, location, histology, surgical and adjuvant treatment, survival, and neurocognitive outcome. Survival has improved. Three quarters of the patients remain alive. The 5-year survival rate was 81%. The 5-year progression-free survival rate was 51%, with a median follow-up time of 70 months. The 5-year survival rate for benign tumors was 100%. None of the children with malignant tumors survived. Morbidity remains high: 8 of 13 survivors had focal neurologic deficits, 7 of 13 had epilepsy, and 7 of 12 had significant cognitive disability. Future treatment protocols should include formal analysis of neurocognitive morbidity, functional outcome, and quality of life measures to provide accurate prognostic information and to prepare families for early intervention programs.