PNR-26INTRACRANIAL NEOPLASMS IN THE FIRST YEAR OF LIFE: RESULTS OF A THIRD COHORT OF PATIENTS FROM A SINGLE INSTITUTION

Abstract

Introduction: Brain tumours in the first year of life are rare and their management remains challenging. We report on the contemporary management of brain tumours in infants with reference to previous institutional series (Kane et al., 1999, Jooma et al., 1984). Methods: Electronic/paper case note review of all brain tumours diagnosed at our institution in children aged,1yr since the publication of our previous series. Results: 100 patients were seen; 56 were male. The most common presentations were vomiting and macrocrania, at a median age of 187d(1-354). 63% of tumours were supratentorial. 92 patients underwent 224 procedures; 8 patients had no surgery. 119 operations were directly on brain tumours (biopsy 39, debulking 47, gross total resection 34). 89 CSF diversions, 10 endoscopic procedures, and 13 pre-operative embolisations were performed. Operative mortality was 2%. The commonest tumours were choroid plexus papillomas(CPP;17). PNET(12). ATRT(10). GBM(9). optic glioma(9). ependymoma(8). LGG(6). pilocytic astrocytoma(6). teratoma(5), with 13 miscellaneous tumours. Survival was 93% at 1m (93/100), 65% at 1y (62/96), 43% at 5y (32/74), 27% at 10y (15/56). No patients with CPP or LGG died. 5-year survival rates were lowest for anaplastic ependymoma/PNET/teratoma. 53% of children reaching school age were in mainstream schooling. Conclusions: Overall survival is similar to previous series. However, increases in the number of CPP and ATRT diagnosed serve to illustrate the two extremes of prognosis in neonatal brain tumours. Future directions for diagnosis and management of this complex group of infants will be considered.