Abstract
Secondary tumors of the skull, the meninges and the brain are said to be rare in children. According to the Annual of the Pathological Autopsy Cases in Japan of 1971 and 1972, there were 173 cases of these secondary tumors in children while there were 196 cases of primary brain tumors. It is, therefore, concluded that these secondary tumors are rather frequent.
Fifty-one fatal cases of secondary tumors of the skull, the meninges and the brain in children treated in the National Cancer Center Hospital (Tokyo) from 1962 to 1974 were studied and were their diagnosis and the treatment discussed, with special emphasis on the indication of surgical removal. These included 18 leukemias, 13 neuroblastomas, 9 retino-blastomas, 8 sarcomas, 2 malignant lymphomas and I embryonal carcinoma. Leukemia: The leptomeningeal infiltration existed in most cases. Diagnosis was made by the evidence of leukemic cells in the cerebrospinal fluid. The intrathecal injection of methotrexate with or without whole-brain irradiation was effective in first course, but was not effective in secound or third courses. The autopsy findings indicated that the typical pattern was the diffuse infiltration of leukemic cells in the leptomeninges and in the subarachnoid space, and multiple intracerebral hematomas accompanied by leukemic cells were occasionally observed. Neuroblastoma : Metastatic skull tumors were palpated in all cases. Autopsy findings revealed that metastatic lesions existed not only in the skull but also in the meninges. Radiotherapy was applied without sufficient effect. Retinoblastoma : The leptomeningeal infiltration with the early consciousness disturbance was characteristic. Intrathecal injection of Methotrexate was not effective. Autopsy findings indicated that tumor cells infiltrated along the optic nerve into the intracranial subarachnoid space, spread diffusely and formed solitary lesions in the hypothalamus, the cerebellum or other intracerebral regions.
Our studies suggest that indication of the neurosurgical removal of tumors is limited for most cases. Early diagnosis and the care under pediatricians and neurosurgeons will bring better prognosis by intensive treatment with chemotherapy, radiotherapy and decompressive operation.
