Incidental brain tumors in children: an international neurosurgical, oncological survey

PURPOSE: Incidental pediatric brain tumors (IPBT) are increasingly being diagnosed. Currently, there is no consensus regarding the need and timing of their treatment. In the current study, we identify trends among pediatric neurosurgeons and oncologists with regard to IPBT management and approval of growth hormone replacement therapy (GHRT). METHODS: A questionnaire presenting six different cases of IPBT was emailed to all members of several leading societies in pediatric neurosurgery and oncology. Collected data included basic information concerning the responders (profession, experience, continent of practice), as well as responses to multiple questions regarding treatment of the lesion, permission to supply GHRT, and free text for comments. RESULTS: One hundred forty-three responses were eligible for analysis (92 neurosurgeons, 51 oncologists, from a total of 6 continents). Initial recommendations for each case were heterogeneous. However, a few consistent trends were identified: Lesions that were stable over time lead to a common shift in treatment recommendation to a more conservative one. Growing lesions were commonly treated more aggressively. Neither profession nor experience had a consistent impact on recommendations. CONCLUSIONS: Management recommendations for IPBT varied among the responders and seem to be influenced by many factors. However, stable lesions lead to a shift in management towards a `watch and wait` approach, while in growing lesions responders tended towards a `biopsy` or `resection` approach. This highlights the need for better understanding of the natural course of incidental brain tumors in children, as well as evaluating the potential risk for malignant transformation.