Clinical aspects and long-term prognosis of infratentorial intracranial tumours in infancy and childhood

An unselected series of 185 children with intracranial tumours in the posterior fossa, aged from birth up to and including 14 years, was followed from 1 to 40 years after diagnosis. Follow-up was 100%. There were 102 boys and 83 girls, i.e. a male/female ratio of 1.22. the same sex ratio was found in all tumour localisations and in most of the histological groups, with the exception of ependymoma, where it was 2.0. All children with tumours in the fourth ventricle or in the cerebellar hemispheres had signs of increased intracranial pressure on admission to hospital, and the duration of these symptoms was less than 6 months in 77% of the children. 113 patients survived for more than 1 month after surgery or diagnosis, and 46 (41%) for at least 15 years. All 34 children with tumours in the brain stem died within the first 2 years of observation, apart from three who survived 4, 5, and 10 years. All but one of the children with medulloblastoma, and all but two with ependymoma died within 1–17 years. Five children with astrocytoma suffered tumour recurrence more than 10 years after primary surgery. One with astrocytoma in the fourth ventricle and 36 with cerebellar astrocytoma survived for at least 15 years. In the survivors the tumour was located in the fourth ventricle in three, in the cerebello-pontine angle in one, and in either the vermis or the cerebellar hemispheres in 42. 41 of these 46 survivors lead a normal life.