Brain & spinal cord tumors

A brain or spinal cord tumor is an abnormal growth of tissue within or around the brain or spine. The tumor can either originate in the brain itself or come from another part of the body and travel to the brain.

Pediatric brain tumors come in many forms and are significantly different from adult brain tumors. They exhibit their own unique behaviors and degrees of malignancy, and they often reside in areas of the brain different from those of adults.

Brain and spinal cord tumors are normally discovered in patients experiencing symptoms such as: headaches, vomiting (usually in the morning), nausea, personality changes, irritability, drowsiness, weakness on one side of the body, seizures, visual disturbances, back pain, and weakness of lower and upper extremities. If your child is experiencing these symptoms, it’s important to have them evaluated by a doctor right away.

Because the nervous system grows rapidly during a child’s early years, a treatment approach to pediatric brain and spinal cord tumors must be selected very carefully in order to avoid injuring healthy, growing cells or causing functional loss. At Cohen Children’s, our dedicated, interactive team of medical specialists, clinical researchers and a professional support group meet this challenge. Our expert team includes:

• Pediatric neurologists: Diagnose neurologic abnormalities and treat seizures
• Pediatric neurosurgeons: Specialize in brain surgery and management of pressure on the brain
• Pediatric neuro-oncologists: Act as coordinators of care, evaluate the nature of the tumor and treat with chemotherapy
• Pediatric neuroradiologists: Plan and read brain and spine CT and MRI scans, including MR imaging, angiography, venography, spectroscopy, functional MRI scanning and brain PET scanning
• Radiation oncologists: Prescribe and design radiation therapy treatments
• Pediatric neuro-psychologists: Evaluate cognitive abilities and make recommendations for improved learning
• Pediatric social workers: Support and counsel families and assist managing insurance
• Designated program coordinators: Ensure patient flow is streamlined
• Child life specialists
• Nutritionists

We also boast a highly functioning, multidisciplinary tumor board. Consisting of neurosurgeons, neurologists, hematologists, oncologists, radiologists, endocrinologists and ophthalmologists, the board meets weekly to review new and existing brain tumor patients, ensuring each child’s treatment gets the unique attention it needs and deserves. Each specialist brings their unique area of expertise to the interactive discussion, helping the group decide on a preliminary approach to treatment. We have a strong relationship with other practitioners in the region, so if another opinion is needed, we reach out to our colleagues at another center, and vice versa.

At Cohen Children’s, we assist patients from the region as well as all over the country and the world using remote consultations. We’re very mindful of the difficulties—both emotional and practical—that a tumor diagnosis brings to a child and their family, and we maintain an environment that is welcoming, educational and compassionate.

We often use MRI for testing rather than CT scan, in order to limit our young patients’ exposure to radiation. We’ve recently opened a brand-new MRI suite on the top floor of Cohen Children’s Medical Center with state-of-the-art 1.5 Tesla and 3.0 Tesla machines. We also have a sedation program specifically for conducting MRI, led by our pediatric anesthesiologists.

Sometimes tumors are caused by genetic disorders, such as neurofibromatosis and tuberous sclerosis. In these cases, we are sure to address genetic components through specific programs such as the neurofibromatosis program. Sometimes a tumor patient already knows they have a genetic disorder, and sometimes we diagnose it.

Our team includes designated program coordinators to ensure that patient flow is streamlined and smooth, as well as social workers, psychologists, child life specialists and nutritionists for added support. We are very mindful of the difficulties—both emotional and practical—that a tumor diagnosis brings to a child and their family, so we maintain an environment that is welcoming, educational and compassionate.

In general, Cohen Children’s uses MRI for testing rather than CT scan, to limit the patient’s exposure to radiation. In fact, we’ve just opened a brand-new MRI suite on the top floor of Cohen Children’s Medical Center with state-of-the-art 1.5 Tesla and 3.0 Tesla machines.  Additionally, we have a sedation program specifically for conducting MRI, led by our pediatric anesthesiologists.

The first step in diagnosing a brain or spinal cord tumor is usually a history and neurological examination, during which a doctor will also review personal and family medical history. If a brain tumor is suspected, the patient will likely need additional tests. We use a variety of imaging tests and other diagnostic methods (typically outpatient procedures) to deliver an accurate diagnosis, including:

• MRI scan (magnetic resonance imaging)—The mainstay of brain and spinal cord imaging, it may be done with or without sedation and with or without intravenous contrast.
• CT or CAT scan (computerized axial tomography)—Uses a combination of X-rays and computer technology to produce detailed images.   
• fMRI scan (functional magnetic resonance imaging)—Specialized MRI allows us to determine the location of certain functions in the brain, such as movement or speech. This can aid in surgical planning and provide some prediction of treatment risk. It is also used during surgery to maximize tumor resection while minimizing complications.
• MR SPECT (magnetic resonance spectroscopy or MRS)—Specialized brain scan that can help determine whether a finding on MRI is a tumor or not.
• Angiogram—After injection of a dye, detailed images of the brain's blood vessels can help guide therapy.
• Spinal tap—The physician uses a thin needle to remove fluid from the lower spine. The fluid is then checked by a pathologist for cancer cells or other signs of problems.
• Bone scan—After a dye is injected and absorbed by bone tissue, images are taken to detect tumors and bone abnormalities.

Once a tumor diagnosis has been confirmed, the doctor will conduct one or more diagnostic imaging tests, such as those listed above, to determine the location of the cancer and whether it has spread.

We offer brain and spinal cord tumor patients the most advanced and diversified treatments, services and technologies, such as:

• Leading-edge surgical procedures—We are committed to using procedures that avoid damage to critical areas. This includes endoscopic procedures, awake craniotomy, skull base approaches through the nose, and operating through a tubular retractor in a minimally invasive fashion.
• LITT (laser interstitial thermal therapy)—Pioneering the minimally invasive treatment of brain tumors with lasers that are inserted through the smallest possible incisions with the highest accuracy.
• Intraoperative imaging via Ceretom CT
• Gamma Knife radiosurgery—Delivers a targeted, spherical volume (a ball) of radiation to target the tumor from different angles. Size can be adjusted by the doctor to fit the shape of the tumor.
• Advanced chemotherapy drugs—Can be taken by mouth, by injection or intravenous line, both in and out of the hospital

There are many approaches available, and your doctor will work with you and your child to identify the most effective one(s), based on your specific case.

Note that, unlike most other cancers, there is no standard staging system for brain and spinal cord tumors. Brain tumors that begin in the brain may spread to other parts of the brain, but they rarely spread to other parts of the body. Treatment is based on the type of cell in which the tumor began, where the tumor formed in the brain or spinal cord, and the amount of cancer left after surgery (if applicable). For brain tumors that have spread to the brain from other parts of the body (metastatic tumors), treatment is based on such factors as the type of tumor a patient has, how many tumors there are in the brain, and how many tumors are elsewhere in the body.

When your child completes treatment, their care will be followed closely by our multidisciplinary team in our brain tumor clinic which includes a neurologist, neuro-oncologist and other ancillary support staff as needed. Our dedicated team of specialists work to decrease any effects associated with treatments and help your child maintain good overall health and optimize their quality of life.