Children

Brain tumors in children.

Brain tumors also occur at a young age. Often, the symptoms overlap with other medical problems, and it can take a long time before a correct diagnosis is made.

The first complaints may be headache (night and early morning) that progressively increases in intensity, vomiting (morning) and increased need for sleep.

The headache may increase with laughing and coughing, and may also manifest itself at the back of the head and neck.

But decreased school performance, reduced activity, or behavioral changes can also occur. Hormonal abnormalities can occur, which in turn can cause symptoms or trigger an epileptic seizure.

Loss of function of the facial/eye muscles or arms and legs may also occur.

The complaints are somewhat age-related.

Given their importance, we have listed them below: (source: UZ Gent webinar, December 2025)

Infants/toddlers/preschoolers .

Persistent - recurring vomiting

Balance/coordination/gait problems

Abnormal eye movements or suspicion of reduced vision

Behavioral changes, lethargy

Convulsions (especially if they occur without fever)

Abnormal position of the head, for example a stiff neck that does not go away

Increasing head circumference (importance of head circumference measurements)

Primary school children

Persistent-recurring headache

Persistent - recurring vomiting

Balance/coordination/gait problems

Abnormal eye movements

Reduced vision, double vision, blurred vision

Behavioral changes

Convulsions (especially if they occur without fever)

Abnormal position of the head, for example a stiff neck that does not go away

Teenagers.

Persistent-recurring headache

Persistent - recurring vomiting

Balance/coordination/gait problems

Abnormal eye movements

Reduced vision, double vision, blurred vision

Behavioral changes

Convulsions (especially if they occur without fever)

Delayed or accelerated pubertal development

The time between the first symptoms and a diagnosis can be prolonged in children. It remains a difficult situation for parents and doctors to assess, and fortunately, the frequency of occurrence is low. However, if problems persist, it should be considered. Delaying diagnosis increases the risk of neurological complications.

Types of tumors

The most common tumors in children are gliomas, particularly astrocytomas, as well as ependymomas and medulloblastomas. There are approximately 120 diagnoses per year.

Reference centers:

After diagnosis, it is important that the child is further monitored and treated in a reference center that specializes in this pathology.

Further course of events:

First, we will ensure a stable and safe situation. For example, in the case of overpressure in the brain, a drainage system can be installed to drain the cerebrospinal fluid through an alternative route and thus control the pressure in the brain.

Further development will be done on the basis of medical imaging and obtaining tissue through first a biopsy or immediate intervention.

The type of tumor and its location will largely determine the extent to which a lesion can be successfully removed. These are often delicate procedures with a risk of bleeding and brain damage, although every effort is made to minimize these complications.

The resulting tissue will be further examined to determine the optimal follow-up treatment. A fingerprint is created, as it were, of the tumor for identification, allowing for the initiation of treatment that targets the most affected tissue. This process does, however, increase the waiting time for a definitive diagnosis.

The outcome depends on many factors and is different for each person. The type of tumor, its grade, its location, the possibility of complete removal, and further molecular testing—all factors play a role.

During surgery, the surgeon's removal of diseased tissue remains a delicate balancing act; removing too much can cause damage and loss of function for the patient, while removing too little increases the risk of recurrence or relapse. Therefore, having a tissue diagnosis during the procedure can significantly influence the surgeon's decision on how far to remove tissue.

Radiotherapy

After surgical treatment, additional treatment may be proposed in the form of radiation or radiotherapy.

There is standard photon radiation therapy, but also a more specialized proton therapy that produces less scattered radiation and therefore causes less damage to healthy tissues surrounding the radiation zone. The choice of treatment also depends on several factors and must be determined by the radiation therapists.

There is a risk of damage from radiation to the developing brain. Therefore, the radiation can cause neurocognitive delays with a certain loss of IQ, but this is difficult to generalize.

Chemotherapy

This therapy is also an option for children, but it has the disadvantage that many side effects can occur.

Target therapy

These rather innovative drug treatments are in full development. They often offer the advantage of being administered as a pill or syrup, have less impact on bone marrow, for example, than chemotherapy often does, and are often effective. Here too, many factors play a role in the decision to initiate this treatment. The long-term disadvantages are also not yet clear. But it does seem to be a positive wind blowing through the treatment landscape.

General

It's clear that many children can benefit from a diagnosis of a brain tumor. However, it's also clear that these treatments can leave scars that can affect a person's functions and organs in the long term. Therefore, proper monitoring is essential, and the consequences of treatments must be addressed appropriately.

Care pathway

Ideally, the patient will be followed by a multidisciplinary team that will continue to monitor the patient closely after treatment. The pediatrician and general practitioner are, of course, part of this team. The latter will monitor the patient at home and contact the hospital team if any abnormalities arise. A nurse consultant can act as a liaison between all healthcare providers.