Tumors of the cerebellum and fourth ventricle in children: late detection in an era of widespread neuroimaging availability

Abstract

Background. Today, tumors of the central nervous system are the leading cause of mortality among pediatric cancers, and the region of the posterior cranial fossa (PCF) is one of the most common localizations. Despite availability of neuroimaging methods, such pediatric tumors are diagnosed long after the onset of appropriate symptoms. Aim. To assess the posterior cranial fossa tumor diagnosis time, initial complaints and symptoms, as well as the events occurring between the advent of complaints and the diagnosis. Methods. The pre-hospital and outpatient care reports of 79 children, who underwent surgery due to intracranial tumors of the posterior cranial fossa in the Burdenko National Medical Research Center of Neurosurgery in 2021-2023, were assessed. The possible causes of delayed proper diagnosis were analyzed. Results. Headache is the main reason for seeking medical care, however, it seldom becomes the reason for magnetic resonance imaging (MRI) in children. The average time between the onset of symptoms and the diagnosis of the PCF tumor is almost 4.5 months. In 37.9% of cases, the MRI scan was the initiative of the patients' parents, and the parents' time frame of independent decision making did not differ from the time frame of the physician's decision to send a child with appropriate symptoms for MRI. In other words, neuroimaging was performed when the condition worsened, and worsening was obvious for anybody without medical training. The low level of concern in primary care providers and the significant systemic causes that slow down the diagnosis are among the reasons of such a long wait for the diagnosis.

Keywords

• pediatric brain tumors
• diagnosis of brain tumors
• headache
• oncology in pediatrics
• pediatric neurosurgery