Facts :Pediatric Brain Tumors. 

• Pediatric brain tumors are the most common type of solid childhood cancer and only second to leukemia as a cause of pediatric malignancies.
• Among all childhood cancers, brain tumours are the leading cause of death.
• Despite advances in medical knowledge, there is no direct cause for brain tumors identified. A combination of genetic and environmental factors is blamed to come into play in the pathogenesis of brain tumours. Multiple known cancer predisposition syndromes show associations with brain tumours, for example, DICER1, Li-Fraumeni, and other neurocutaneous syndromes such as neurofibromatosis, tuberous sclerosis, and Von-Hippel Lindau.
• Family history may play a role in the aetiology as many studies report an association of brain tumours and siblings.
• The parental age at birth may also play a role. Studies show that offspring are at high risk for brain cancer (astrocytoma and ependymoma) in women who are older than 40.
• Several studies have suggested a link between infectious exposure during childhood and brain cancer, but this topic remains debatable.
• High dose radiation has been linked to brain malignancies. Children who have received radiation for leukemia are known to be at risk for developing brain cancer.
• The principal treatment for brain tumoursis surgery aiming for gross total resection. The extent of the brain tumoursand the general condition of the patient are important determinants of surgical outcome. Adjuvant therapies are not commonly used in neonates. Craniospinal radiotherapy results in significant developmental retardation and is avoided during the first 3 years of life.
• Congenital brain tumours have a poor prognosis with overall survival of less than 30%.Several factors such as malignant histological type, size, and location of the tumour, stage of foetal development, and treatment-related complications play a significant role in survival outcomes.
• Early detection of brain tumours and prompt referral to paediatric neurosurgery and paediatric neuro-oncology teams is vital. This usually starts with the paediatrician, nurse practitioner, family physician or emergency physician. The optimum care of patients with brain tumours occurs through an interprofessional collaboration including oncology, diagnostic imaging, pathology, radiotherapy, nursing, rehabilitation, and social workers.

Moving forward

• Children who survive treatment via surgical removal develop neurological consequences from said surgery. More studies are necessary to understand the impact that different treatment options, tumour pathology, and tumour location have on neurological outcome.
• Brain tumours in childrenare challenging to treat surgically. 
• The principal treatment for brain tumours is surgery aiming for gross total resection. The extent of the brain tumours and the general condition of the patient are important determinants of surgical outcome. Adjuvant therapies are not commonly used in neonates. Craniospinal radiotherapy results in significant developmental retardation and is avoided during the first 3 years of life.
• This is a problem as there is no satisfactory brain maps for children, unlike the many brain maps that exist for adults.
• There are limited neuroanatomical resources devoted to the child, hence the status quois that paediatricians are trained in adult neuroanatomy and they must translate from the adult to their young patients. Clinicians rarely have the time, expertise, or resources to obtain and segment high resolution images of the child brain.
• There are new resources being developed in Australia that will make the highest resolution brain maps of the child, natively obtained from child MRI scans. Such a resource will, when complete assist in surgical treatment of children’s brain cancer.