**8. Histologic confirmation of diagnosis**

Histopathologic diagnosis of brain tumours is necessary for decision making regarding appropriate management. Stereotactic biopsy has emerged as a comparatively safe method of histological diagnosis and has significantly reduced the risks associated with brain biopsy [16]. Tissue sampling can be obtained either with stereotactic, open, or endoscopic procedures and, overall, provides.

Greater than 90% diagnostic yield, while it may be significantly lower (60–70%) in small (<1 cm3 ) and/or heterogeneous lesions [17].

#### **8.1 Open biopsy**

It is performed as an open technique by intraoperative neuronavigation. Typically, it is asserted for surface brain lesion, where hemostasis is critically vital or a surgical resection depending on frozen section histopathology is arranged. Although morbidity and mortality of open biopsy is more as compared to stereotactic biopsy but neoplastic tissue yield is better and it influences the likelihood of an accurate diagnosis.

#### **8.2 Stereotactic biopsy**

It can be frame based and frameless. The frame-based method is focused on the fixation of the stereotactic frame on the patient's head, whereupon the localizer is attached to the frame with many N-shaped posts. Under stereotactic circumstances, neuroimaging (CT, MRI, positron emission tomography [PET], etc.) is carried out and radiological information is transmitted to the specialized computer platform. The localizer posts are used as space coordinate references. For optimizing the target location and defining the ideal trajectory for biopsy, multiple pictures are combined.

The frameless biopsies are generally technically easier and require less preparatory efforts in comparison to frame-based ones [18].

#### **8.3 Endoscopic biopsy**

It is recommended for intra- and periventricular tumors and can be done with or without frameless stereotactic guidance. The advantages of this technique are


In case obstructive hydrocephalus, third ventriculostomy can be simultaneously done [10].

Exception may be produced in chosen patients such as patients with known active systemic cancer and numerous lesions radiographically associated with brain metastases, patients with classic clinical and MRI results of brain stem glioma or optic nerve meningioma, HIV-positive patients with CT or MRI results consistent with primary CNS lymphoma and positive Epstein-Barr virus polymerase chain reaction in the CSF, or patients with secretory germ-cell tumors [19].

**155**

*An Overview of Pediatric CNS Malignancies DOI: http://dx.doi.org/10.5772/intechopen.88189*

smooth thin walls and restricted diffusion within cavity.

Subdural hematoma: anemia, retinal hemorrhage.

Primary-solitary, no prior cancer.

**10. General management**

syndrome tuberculoma: exposure to tuberculosis.

components of the neurological examination.

remain a generally accepted treatment.

**11. Neurosurgical procedure**

• Tissue diagnosis

Abscess-fever, acutely ill, ±systemic infection, ct findings show cyst cavity with

Cerebritis-fever, acutely ill, ±systemic infection, mri findings show diffuse T2 change, no mass meningitis-diffuse enhancement of meninges on T1-weighted imaging.

Infarct—MRI findings show Gray and white matter involvement, wedge like

Treatment-related necrosis—central hypodensity, edema, >6 months after

Metastatic-multiple, prior cancer, ++edema, located at gray/white junction hydrocephalus: headache, vomiting, subarachnoid hemorrhage, Guillain-Barré

A focused history and symptom-based neurological examination is required which may be sufficient to raise brain tumor suspicion. Mental status assessment, cranial nerves, motor skills, sensory examination, coordination, and gait are key

Preoperative laboratory testing which includes a complete blood cell count, renal

Although there is little evidence to support the use of corticosteroids with regard to overall outcome, corticosteroids can relieve headache, nausea, and vomiting and

In assessing a child suspected of having a brain tumor, a thorough neurological examination is of critical importance. Most kids diagnosed with a brain tumor have

Surgery remains the main treatment modality for most pediatric brain tumors.

and hepaic profile. A baseline ophthalmologic evaluation, including visual field testing and fundoscopic evaluation, is important in preoperative evaluations because most patients do not complain of visual field deficits at presentation. Glucocorticoids

are used to control neurologic signs and symptoms caused by cerebral edema.

abnormal results on the presentation of neurological examination [20].

Depending on tumor type, the goals of surgical intervention are:

• Re-establishment of normal CSF pathways

vascular distribution associated with restricted diffusion and low signal.

Bleeding—homogenous, clears quickly, residual hemosiderin ring.

radiation therapy or chemotherapy, metabolic scan shows low activity.

Pseudotumor cerebri: after otitis media, hormonal abnormalities.

**9. Differential diagnosis**

**9.1 Infectious**

**9.2 Vascular**

**9.3 Neoplasm**
