Tumors of the central nervous system win first place on frequency among solid malignant tumours at children, making 20 % of all oncological desease in children's age. These tumors occurs frequency 2-2,8 on 100000 children's population, taking the second place among the reasons of death of children with an oncological pathology. Children of preschool age fall ill more often: the peak of desease is necessary for 2-7 years. Though the parameter lethality from these tumours till now exceeds lethality's parameters at many malignant processes at children, modern therapeutic approaches and advanced achievements in the diagnostic opportunities, allowing early to diagnose a tumour and precisely to plan treatment, allow to cure a lot of children.
Etiology of this group of tumors now it is unknown, though there are data about predisposition of patients for example, with neurofibromatosis, to occurrence at them glioma a brain. Communication of occurrence neurogliocytoma at children with a syndrome basocellular nevus (defeat of a skin, anomaly of a skeleton, a leather, brushes, feet and anomalies of central nervous system) is known. The raised desease of tumors of a brain is marked at children with a congenital immunodeficiency, at children with ataxia-venous lake.
Often tumor of a brain arises as the second tumor at children, suffering sharp leukosis, a hepatocellular cancer, adrenocortical tumors. All these data attest to availability of some contributory causes for progress of malignant tumours of a brain, to decipher which and to define their influence on the forecast it is necessary in the future.
Classification of tumors of a brain at children.
According to the international classification the CART (1990, the second edition) biological behaviour of tumours central nervous system it is defined (in addition to presence of histologic features of a differentiation) so-called, a degree malignity or anaplasia: from I (good-quality) up to IV (malignant). To tumors low degrees of malignity belong to tumor I-II of a degree (Low grade), to a high degree of malignity
- III-IV degrees (High grade).
The histologic structure of tumours of a brain at children significantly differs from those at adults. Meningiomas, neurilemmomas, tumors of a hypophysis and metastasises from other bodies which rather often amaze brain of adult patients, very seldom meet at children's age. At children of 70 % of tumours make gliomas.
The first classification of tumors of a brain has been offered in 20th years of our century Bailey and Cushing. This classification is based on histogenesis fabrics of a brain and the subsequent classifications have all in to the basis this principle.
The tumors of a brain diagnosed for children of the first years of a life, have the central arrangement, i.e. amaze more often the third ventricle, hypothalamus, chiasm optic nerves, an average brain, the bridge, a cerebellum and the fourth ventricle. In spite of the fact that the volume of substance of a brain of a back cranial pole makes only the tenth part from all volume of a brain, more than half of all malignant tumors of a brain at children is more senior than 1 year make tumors of a back cranial pole. It mainly - neurogliocytoma, cerebellar astrocytoma, gliomas of a trunk of a brain and ependymoma the fourth ventricle,.
Clinical picture.
Generally speaking, any tumor of a brain has malignant behaviour irrespective of it the histologic nature as its growth occurs in the limited volume, and irrespective of the histologic nature of a tumour the clinical picture of all tumours of a brain is defined, mainly, localization of tumoral growth, age and a preclinical level of development of the sick child.
Central nervous system neoplasms can cause neurologic frustration by direct infiltration or prelum normal structures, or mediated, causing of obstruction neurolymph ways.
The factor defining dominating symptoms at children by tumours of a brain, the raised intracranial pressure is, in consequence of that there is a classical triad - a morning headache, vomiting and drowsiness. Heavy, anticipate the headache seldom arises at children, but it is especially important to pay attention to this complaint. Spasmes - the second symptom on frequency after a headache, especially at children with suprasternal tumors. Approximately at a quarter of such patients of a spasm are the first demonstration of a tumour. Sometimes these children aspire to incline a head in one party. Involving in process of a cerebellum can cause ataxia, nystagmus and others cerebellar frustration.
Diagnostic.
Besides routine clinical inspections, including survey of the oculist, to such children should be necessarily lead CT and MRT with contrast substance head and a spinal cord. Especially at localization of a tumor in back to pole MRT it is extremely informative, as this method has greater resolution. These researches with success have replaced intrusive procedures - arterial angiography or air ventriculography.
Histologic verification of a tumor is necessary, but is at times complicated because of the technical difficulties connected with localization of a tumour, involving in process the vitally-important structures. Now with gradual ocurrence in practice of neurosurgeons of a new hi-tech method of operative intervention - stereotactic surgeries begins possible to make biopsy tumors practically any localization. Sometimes in communication with substantial growth of intracranial pressure by a first step operation of shunting is, that considerably improves the neurologic status of the patient.
Cerebrospinal research will give a-brain liquid the information about possible extracratonal distribution of malignant process. In rare cases of distribution of a tumor for central nervous system limits (for example, at presence neurogliocytoma) carrying out of additional diagnostic actions, such as x-ray of a thorax, ultrasonic of a belly cavity, myelogram is necessary.
Etiology of this group of tumors now it is unknown, though there are data about predisposition of patients for example, with neurofibromatosis, to occurrence at them glioma a brain. Communication of occurrence neurogliocytoma at children with a syndrome basocellular nevus (defeat of a skin, anomaly of a skeleton, a leather, brushes, feet and anomalies of central nervous system) is known. The raised desease of tumors of a brain is marked at children with a congenital immunodeficiency, at children with ataxia-venous lake.
Often tumor of a brain arises as the second tumor at children, suffering sharp leukosis, a hepatocellular cancer, adrenocortical tumors. All these data attest to availability of some contributory causes for progress of malignant tumours of a brain, to decipher which and to define their influence on the forecast it is necessary in the future.
Classification of tumors of a brain at children.
According to the international classification the CART (1990, the second edition) biological behaviour of tumours central nervous system it is defined (in addition to presence of histologic features of a differentiation) so-called, a degree malignity or anaplasia: from I (good-quality) up to IV (malignant). To tumors low degrees of malignity belong to tumor I-II of a degree (Low grade), to a high degree of malignity
- III-IV degrees (High grade).
The histologic structure of tumours of a brain at children significantly differs from those at adults. Meningiomas, neurilemmomas, tumors of a hypophysis and metastasises from other bodies which rather often amaze brain of adult patients, very seldom meet at children's age. At children of 70 % of tumours make gliomas.
The first classification of tumors of a brain has been offered in 20th years of our century Bailey and Cushing. This classification is based on histogenesis fabrics of a brain and the subsequent classifications have all in to the basis this principle.
The tumors of a brain diagnosed for children of the first years of a life, have the central arrangement, i.e. amaze more often the third ventricle, hypothalamus, chiasm optic nerves, an average brain, the bridge, a cerebellum and the fourth ventricle. In spite of the fact that the volume of substance of a brain of a back cranial pole makes only the tenth part from all volume of a brain, more than half of all malignant tumors of a brain at children is more senior than 1 year make tumors of a back cranial pole. It mainly - neurogliocytoma, cerebellar astrocytoma, gliomas of a trunk of a brain and ependymoma the fourth ventricle,.
Clinical picture.
Generally speaking, any tumor of a brain has malignant behaviour irrespective of it the histologic nature as its growth occurs in the limited volume, and irrespective of the histologic nature of a tumour the clinical picture of all tumours of a brain is defined, mainly, localization of tumoral growth, age and a preclinical level of development of the sick child.
Central nervous system neoplasms can cause neurologic frustration by direct infiltration or prelum normal structures, or mediated, causing of obstruction neurolymph ways.
The factor defining dominating symptoms at children by tumours of a brain, the raised intracranial pressure is, in consequence of that there is a classical triad - a morning headache, vomiting and drowsiness. Heavy, anticipate the headache seldom arises at children, but it is especially important to pay attention to this complaint. Spasmes - the second symptom on frequency after a headache, especially at children with suprasternal tumors. Approximately at a quarter of such patients of a spasm are the first demonstration of a tumour. Sometimes these children aspire to incline a head in one party. Involving in process of a cerebellum can cause ataxia, nystagmus and others cerebellar frustration.
Diagnostic.
Besides routine clinical inspections, including survey of the oculist, to such children should be necessarily lead CT and MRT with contrast substance head and a spinal cord. Especially at localization of a tumor in back to pole MRT it is extremely informative, as this method has greater resolution. These researches with success have replaced intrusive procedures - arterial angiography or air ventriculography.
Histologic verification of a tumor is necessary, but is at times complicated because of the technical difficulties connected with localization of a tumour, involving in process the vitally-important structures. Now with gradual ocurrence in practice of neurosurgeons of a new hi-tech method of operative intervention - stereotactic surgeries begins possible to make biopsy tumors practically any localization. Sometimes in communication with substantial growth of intracranial pressure by a first step operation of shunting is, that considerably improves the neurologic status of the patient.
Cerebrospinal research will give a-brain liquid the information about possible extracratonal distribution of malignant process. In rare cases of distribution of a tumor for central nervous system limits (for example, at presence neurogliocytoma) carrying out of additional diagnostic actions, such as x-ray of a thorax, ultrasonic of a belly cavity, myelogram is necessary.
