Watch for These Symptoms in Children

Associate Professor Gökalp Silav from the Department of Brain, Nerve and Spinal Surgery at Memorial Şişli Hospital made important comments about brain tumors in children and treatment methods. Silav stated, "Brain tumors, which are among the frequently occurring tumors in childhood, can present different symptoms in children compared to adults. Brain tumors, whose most commonly known initial symptom is headache, are more difficult to diagnose in infants and young children who cannot fully express their complaints. Parents need to carefully observe changes occurring in children, such as a child learning to walk frequently falling. In later stages, seizures, imbalance, vision problems, walking disorders, and a range of hormonal disturbances up to loss of consciousness can develop" he said.

Attention to Brain Tumors in the Newborn Period

The most important known symptom of brain tumor in adults is severe headache. However, infants and children cannot fully express their complaints. The vast majority of brain tumors appearing in the newborn period stem from developmental problems in the womb. These tumors, which typically present symptoms in the first few weeks of life, may have a worse course. In newborn infants, the head circumference grows on average 1 cm per month. Tumors appearing before the fusion of skull bones can cause much faster head growth. Measuring and recording the infant's head circumference during routine check-ups can be vitally important. Parents should carefully monitor the responses that a newborn baby should give.

• If the baby is constantly drowsy,
• If having difficulty staying awake,
• If in an unusually immobile state, as commonly described as lying like pudding,
• If unable to raise the head in a manner consistent with age,
• If constantly lethargic,
• If experiencing feeding problems, a doctor should be consulted as soon as possible.

Children Need Close Observation

While 2 to 3-year-old children begin to learn speech compared to infants, they still cannot express their problems like an adult. Children who have difficulty expressing symptoms such as headache especially need to be carefully observed during this period. In children this age, brain tumors can manifest through signs such as hair pulling as an expression of headache, crying, restlessness, and loss of appetite. Brain tumors can appear with different symptoms in children during this period compared to infants.

• Regression in abilities previously acquired by the child,
• Starting to fall frequently despite learning to walk,
• A child with established toilet control beginning to have urinary incontinence,
• Weakness on one side of the body,
• Eye deviation or focusing problems,
• Swallowing difficulties,
• General deterioration in the child's feeding,
• Appearance of hormonal signs inconsistent with age.

Contrast-Enhanced MRI Under Anesthesia is Preferred in Children

There are some differences in the diagnosis and treatment of brain tumors in children compared to adults. Generally, children who come to the hospital upon suspicion by families or pediatricians conducting routine follow-ups require an MRI for diagnosis. Since remaining motionless inside the MRI machine is necessary to obtain a high-quality MRI image, contrast-enhanced MRI under anesthesia is preferred in children. Since radiotherapy cannot be used in children up to a certain age, it is important that as much of the tumor as possible be removed during surgical treatment. In cases where the tumor can be completely removed by surgical methods, recovery is much faster and healthier development occurs. In addition to surgical treatment, chemotherapy applications for children and follow-up at frequent intervals may be recommended. Due to the softer skull in children, head-fixation devices used during surgery cannot be employed. High technologies such as neuromonitoring (monitoring of brain electrical activity), neuronavigation (computer-assisted anatomical localization system), and intraoperative open brain ultrasound providing crucial information during surgery must be used to provide the surgeon a safer path during the operation. For successful treatment of brain tumors in infants and children, a multidisciplinary approach must be conducted with collaboration among a brain surgeon experienced in pediatric tumor microsurgical techniques, pediatric oncology, radiology, and pediatric neurology specialties working together.