2. Pediatric brain tumors(PBT) are 15-20% of all
brain tumors. Second most common
pediatric tumor next to leukemia.
Overall, supratentorial and infratentorial
tumors occur in equal frequency.
Supratentorial more common <2yrs;
infratentorial more common 4-10 yrs; equally
common after 10yrs age
12. Local intracranial extension from
extracranial neoplasms
• Chordoma
• Paraganglioma
• Carcinomas (e.g., nasopharyngeal squamous
cell),sarcomas (rhabdomyosarcoma)
13. Neoplasms that often have cyst + nodule
• Pilocytic astrocytoma
• Ganglioglioma
• Hemangioblastoma
• Craniopharyngioma
14. 30% of hemispheric tumors. Most common
cerebral hemispheric tumor
Peak incidence at 7-8yrs age
Low grade astrocytomas more common
Glioblastoma Multiforme (GBM)WHO IV/IV ~
20%
Typically involve basal ganglia, thalamus
Can be multi-centric
15. Cerebellum is most common site followed by in
and around optic nerve/chiasm,
hypothalamus/third ventricle.
Cerebral hemisphere –uncommon.
Cerebellum and cerebralTm: cyst with mural
nodule.
Optic nerve/chiasm/third ventricle: solid
infiltrating.
Hemorrhage uncommon; if present its
pilomyxoid astrocytoma
16. SagittalT2WI shows a
mixed solid and cystic focal lesion in the
right frontoparietal region (arrows).The
solid component of the lesion has
intermediate
signal, and the cystic component has
high signal.
Sagittal postcontrastT1WI
shows prominent Gd-contrast enhancement
at the solid component of the lesion
18. Differs from PA in clinical course,
presentation and histological appearance.
60%- suprasellar, 40%cerebral hemisphere
Cerebellum and fourth ventricle ;rare
Age: Suprasellar- infants and children <4 yrs
Atypical location – adolescent and in adults
Imaging: A large H shaped suprasellar mass,
mixed SI, heterogeneous enhancement with
hemorrhage
20. First two decades of life, mean age 11 yrs
An enhancing lesion at foramen of Monro
should be considered SEGA until proven
otherwise.
Calcification,
TSC other feature; SEN, cortical tubers, white
matter radial migration lines
SEGA or SEN; progressive enlargement.
22. Children and young adults, 2/3rd under 18 yr
Well delineated cortically based mass that
contacts the leptomeninges
70%; cyst with nodule, 30% solid with
intratumoral cysts
Calcification 40%, hemorrhage rare
Moderate enhancement ofTm nodule post
contrast
24. 30% of ependymomas
Peak incidence between 1-5yrs age
Histologically similar to infratentorial
ependymomas – fourth ventricle and CPA.
Differs! typically in periventricular white
matter and cerebral hemisphere
parenchyma.
25. AxialT2WI
shows a lesion with heterogenous high signal
containing a cystic zone in the inferior
right frontal lobe.
Postcontrast axialT1WI
shows irregular peripheral enhancement at
lesion.
26. Arises from subpial astrocytes
Found between1-months age w/peak at 3-6
months. Occasionally seen up to 5yrs
Cortically based tumor nodule.
28. Imaging findings:
Large cyst w/cortically based enhancing tumor
nodule
Solid component avidly enhances;
leptomeningeal and dural enhancement,
enhancement
Occupies majority of cerebral hemisphere
Looks worse than it is!!
Greater then 75% survival after 15yrs
w/complete resection
29. Cause of 20% cases of medically refractory
epilepsy
60% in temporal lobe, 30% frontal lobe
Solid and cystic tumors
Scalloping of inner table skull
Associated w/cortical dysplasia
Slow to No growth!
33. Found in adolescents
Associated with mesial temporal sclerosis
Most common in temporal, parietal, frontal
lobes
Difference betweenGG and GC is histological
Clinical: Partial complex seizures
34. Imaging findings:
•Solid or cystic or cyst w/mural
nodule
•Variable enhancement
•35% w/calcifications
•If peripheral location, then
scalloping of adjacent calvarium
•Hemorrhage and necrosis absent
38. a AxialT2WI shows a large lesion
with heterogeneous high signal in the right
frontal lobe extending across the corpus
callosum to the left frontal lobe
b Postcontrast
sagittalT1WI shows irregular enhancement
in a portion of the lesion.
39. occur in the paediatric population, usually
during the first 10 years of life,
Circumscribed or invasive lesions. Low to
intermediate signal onT1WI; intermediate to
high signal onT2WI.
VariableGd-contrast enhancement.
Frequent dissemination into the
leptomeninges.
Highly malignant tumors located in the
cerebrum,pineal gland, and cerebellum.
40. 2-5% of tumors in children less then 15 yrs
Midline lesion typically in pineal gland, third
ventricle
Most are benign
41. Imaging findings:
Midline mass with calcifications and fat
Enhancement of soft tissue components
Malignant teratomas have more vasogenic
edema, irregular, less well defined.
46. Arise from epithelium of choroid plexus
5% of supratentorial tumors
Typically age 1-5yrs
Male predominance
Most common in trigone of left lateral
ventricle
CPC more irregular and invasive then CPP but
diagnosis is histological
Clinical: Hydrocephalus
47. Imaging:
CPP is lobulated, homogeneous mass with
frond like excrescence.
Punctate calcifications, hyperdense on CT
Intense enhancement on CT/MR
CPC irregular, heterogeneous w/cystic
necrosis, invasive and vasogenic edema
56. Thought to arise from remnant of
craniopharyngeal duct.
Adamantinomatous(children) and papillary
(adults) types
15% supratentorial tumors, 50% suprasellar
tumors
2 peaks: 10-14 yrs age; 4th to 6th decade of
life
57. Rim enhancement of cysts; heterogeneous enhancement solid portions
60. Benign epithelial lined cyst in sella
Arises from remnants of Rathke pouch in
pituitary gland with frequent suprasellar
extension.
Rare in children
62. Suprasellar type arises from optic chiasm or
hypothalamus
M=F 4yrs age
30-50% have family history of NF1
Clinical: Hydrocephalus, decreased vision,
pituitary dysfunction (short stature)
63. Imaging findings:
T2, FLAIR hyperintense
Fusiform or lobulated enlargement optic
nerves with heterogeneous enhancement
Gliomas in patients without NF1 have cystic
components.
65. Imaging findings:
MR: Infundibular thickening w/uniform
enhancement
Iso to hypointense onT1,T2 and FLAIR
When large, can have areas of cystic necrosis
REMEMBER: HIGH ASSOCIATION
W/DIABETES INSIPIDUS!!.
67. Heterotopic gray matter generally located in
tuber cinereum
Can originate from floor third ventricle,
mamillary bodies.
Can be sessile or pedunculated
Large lesions cause gelastic seizures; small
lesions have precocious puberty
Found in 33% of patients w/precocious
puberty