•Hemangioblastoma (rare)

•Differential diagnosis: non-Hodgkin lymphoma

•Often large cysts are present

•Mostly slow growing, but can extend to vertebrae and compress normal tissue

•Leptomeningeal dissemination occurs in more than 50% of children

9.12.10.3 Symptoms

Back pain, disturbances with sensory or motor deficits (>50%), spinal deformities (30–40%), sphincter dysfunction (20%)

9.12.10.4 Prognosis

• Depending on tumor type, often slow progression; symptoms may be interrupted by surgical resection and/or laminectomy (enlargement of space for the residual tumor)

9.12.10.5 Therapy

•Surgical procedure:

–Occasionally complete resection with osteoplastic laminectomy is possible

–Ependymoma requires radical resection

–Postoperatively close orthopedic observation and intervention: deformations of vertebrae develop within 3 years after surgery in 35–45% of children

•The approach of radiotherapy depends on histology, tumor growth, and extension, as well as symptoms

•Chemotherapy depends on tumor type

9.13Adverse Late Effects from Brain Tumors and Their Treatment

•In contrast to other childhood tumors, and despite successful therapies, the morbidity and the rate of adverse long-term sequelae are high for CNS tumors

•Often the initial symptoms and deficits are persistent

•Both tumorand intervention-related physical, neurological, endocrinological, and/or cognitive deficits and sequelae may be responsible for influence on quality of life

•The risk of a secondary cancer is high

•Multidisciplinary coordination of care should include:

–Support for patients with neurocognitive disturbances

–Neuroendocrine substitutive treatment for normal growth, puberty, and sexual development, and normal functioning of the thyroid gland, hypothalamic– pituitary axis, etc

–Audiological and visual aids and support

–Integration on educational, social, psychological, and cultural levels