Neurosurgical Management of Pediatric Central Nervous System Tumors

Abstract Pediatric brain and spinal cord tumors are the cause of significant morbidity in children. While pediatric spinal cord tumors are rare, brain tumors are the most common solid tumor in the pediatric population. Often, these tumors have a limited response to medical therapies or patients might have contraindications for radiation. Hence maximal surgical removal of these tumors is a common primary method of treatment. Furthermore, maximal safe tumor resection offers decompression, which might lead to clinical improvement and is crucial to establish a pathological diagnosis and inform further treatment recommendations. Secondary spinal cord involvement of tumors in the pediatric population is rare because primary systemic cancer metastases occur infrequently in this age group. Primary spinal cord tumors are encountered infrequently, have limited treatment options, and require careful neurosurgical and treatment considerations. There is growing research interest in pediatric nervous system tumors with multiple ongoing trials, many with promising results for better oncologic therapies. Advanced imaging as well as advances in genetic and molecular understanding of pediatric central nervous system tumors have also helped to broaden therapeutic options for tumors that were previously deemed inoperable or otherwise difficult to manage. With many gaps remaining in the field of pediatric neuro-oncology and neurosurgical oncology, there is a need for continued patient enrollment into clinical trials to advance the field through improved evidence-based management options.