Tumors of the central nervous system are the second-most common group of childhood neoplasms, after leukemia and lymphoma. Children affected by brain tumors have clinical presentations that vary with patient's age and location and growth rate of the mass. Infants can present with vomiting or lethargy, cranial nerve or motor dysfunction, or an enlarging head size due to hydrocephalus. Older children can present with positional headaches, nausea and vomiting, confusion, seizures, cranial nerve or motor deficits, or ataxia. Tumors in the sellar, supra-sellar or hypo-thalamic region can lead to diabetes insipidus, growth failure, amenorrhea or precocious puberty by disrupting the hypothalamic-pituitary axis. Children with pineal region masses often present with hydrocephalus, diplopia or Parinaud's sign (impairment of upward gaze). Clinical features of pediatric brain tumors are discussed in greater detail in Chapter 4.
When any brain tumor is discovered on an imaging study, an appropriate differential diagnosis can be offered by answering several questions. Is the tumor extra- or intra-axial? Is the tumor infratentorial (i.e., posterior fossa), or supratentorial? Is it hemispheric, sellar, suprasellar, or in the vicinity of the pineal gland? What additional distinguishing imaging characteristics does the mass display? Various imaging features of pediatric brain tumors are listed in Tables 8-12.
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