Patients presenting to the Children’s Hospital of Eastern Ontario (CHEO) through the last 34 years with intracranial tumor in the first year of life were reviewed retrospectively for symptoms, management, and functional outcome. Of 18 cases identified, 12 were supratentorial (8 benign) and 6 infratentorial (all malignant histology). They represented 4.8% of all pediatric brain tumors seen over that period. Eight were of glial origin (7 supratentorial), 4 neuroectodermal, 2 teratoid rhabdoid, 2 choroid plexus, 1 meningioma, and 1 teratoma. Median age of presentation differed by lesion location, but not duration of symptoms. Raised intracranial pressure was more than twice as prevalent with posterior lesions and increased head circumference. Seizures occurred in 9 (50%); the tumor was supratentorial in 67% and infratentorial in 17% (p=0.04). Torticollis occurred in 4 (67%) of infratentorial and none of supratentorial tumors (p<0.01). Total resection was performed in 47%, and CSF shunt was more frequent with infratentorial tumor. Adjuvant chemotherapy was given in 44%, and radiotherapy in 17%, mainly in infratentorial tumors. Eight survived, 7 with supratentorial tumor, 5 to adulthood. Six are functionally independent. [1]

COMMENT. In this young age group (<1 year of age), seizures occurred in 50% of patients, mainly with supratentorial tumors. In a study of 291 children with intracranial tumors treated at the Mayo Clinic over a ten-year period, seizures occurred in 17%; the tumor was supratentorial in 62% and infratentorial in 38%. Average age at seizure onset and at diagnosis was 4.9 and 6.7 years, respectively, in patients with supratentorial, and 4.8 and 5.1 years in those with infratentorial tumors. EEG was of localizing value in 75% of supratentorial tumors (88% of cortical tumors). A generalized dysrhythmia, maximal in the occipital regions and compatible with a lesion in the posterior fossa, was present in 44% of patients with infratentorial tumor. A delta pattern, indicative of an expanding lesion, occurred in 57% patients. [2]