Top doctors: Childhood brain tumors

Every day, there are Long Island families coping with the heartache of a child with brain cancer -- the second most common childhood cancer after leukemia and the deadliest overall.

However, most kids with brain tumors can be cured. Here's what you should know:

A child is extremely unlikely to develop a brain tumor. The Pediatric Brain Tumor Foundation reports that about 4,150 children in the United States are diagnosed with brain cancer each year. Several types of brain cancer in children develop in the early ages -- before age 10 and often between 5 and 8 years of age, according to the U.S. National Institutes of Health.

Some children are susceptible to brain cancer from the moment they're born because of the presence of abnormal cells, said Dr. Mary Andriola, director of child neurology and clinical neurophysiology at Stony Brook University Medical Center.

The most common type of brain tumor in kids is called medulloblastoma, which strikes in the back of the brain, said Dr. Mark A. Mittler, co-chief of pediatric neurosurgery at Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park.

"The treatment for medulloblastoma consists of complete surgical removal, when possible, followed by a course of chemotherapy and sometimes radiation therapy," Mittler said. "The treatment success of medulloblastoma has improved dramatically over the past 20 years, and the vast majority of these children are curable in centers that have the proper expertise."

It's rare for medulloblastomas to occur in adults, he said, whereas glioblastomas -- another kind of tumor -- appear in adults but are rare in kids. "Prognosis for glioblastoma remains very poor despite aggressive surgery, chemotherapy and radiation treatment," Mittler said.

"One of the classic symptoms of a brain tumor is a headache that is frequently present upon waking up in the morning," Mittler said. "This should always be evaluated by a pediatrician or pediatric neurologist."

Other symptoms include dizziness, unexplained vomiting and even coma, Mittler said. In some cases, a child will first go to a gastroenterologist to be treated for nausea and vomiting before anyone realizes he or she has a brain tumor, he said.

Andriola mentioned other symptoms that could be indicative of a brain tumor, such as seizures, imbalance, vision changes, unusual eye movement and changes in behavior and alertness. Symptoms often occur, she said, because "there's not enough room in the head to accommodate the brain, the mass that's growing and the swelling that often grows around the tumor."

MRI scans help doctors determine if a child has a brain tumor, Andriola said. If so, the next step is "usually some type of surgery, either to get the whole tumor out or at least to biopsy it to plan treatment if total removal would cause more harm than good," she said. In some cases, she explained, it may be unwise to remove an entire tumor because it's too close to crucial parts of the brain.

Radiation is sometimes used as a treatment in children, Andriola said, but with radiation comes significant potential for long-term side effects.

Scientists and physicians are developing and testing several treatments, including new drugs and drug combinations that may slow tumor growth, and radiation treatment that could decrease side effects by more effectively targeting tumors.

Andriola said that genetic testing of children and their tumors also has the potential to help doctors better understand the structure of tumors and determine which sections to remove, and improvements in scanning technology could provide more important details about tumors.

Neurologists, neurological surgeons and neuroradiologists

This is the 25th installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.

1991 Marcus Ave.

516-466-4700

370 E. Main St.

631-666-4767

Medical Center

Dept. Neurology

HSC T12, Rm. 020

Stony Brook

631-444-2599

Neurological Surgery, PC

1991 Marcus Ave.

516-442-2250

Medical Center

Dept. Neurology

HSC Bldg. Fl. 12-Rm. 020

Stony Brook

631-444-2599

LI Jewish Medical Ctr.

Dept. Neurology

270-05 76th Ave.

718-470-7366

170 Great Neck Rd.

516-487-4464

3 Delaware Dr.

516-622-6088

L.I. Jewish Medical Ctr.

Dept. Neurology

270-05 76th Ave.

718-470-7311

824 Old Country Rd.

516-822-2230

1991 Marcus Ave.

516-466-4700

865 Northern Blvd.

516-570-4400

777 Sunrise Hwy.

516-887-3516

L.I. Jewish Medical Ctr.

Dept. Neurology

270-05 76th Ave.

718-470-7311

877 E. Main St.

631-727-0660

824 Old Country Rd.

516-822-2230

1010 Northern Blvd.

516-482-4100

1575 Hillside Ave.

New Hyde Park

516-352-2441

824 Old Country Rd.

516-822-2230

Med. Ctr., Dept. Neurology, HSC T12-020

Stony Brook

631-444-2599

3003 New Hyde

Park Rd.

New Hyde Park

516-488-2323

410 Lakeville Rd.

New Hyde Park

516-465-5255

Dept. Ped. Neurology

410 Lakeville Rd.

New Hyde Park

516-465-5255

600 Northern Blvd.

Great Neck

516-478-0008

24 Research Way

631-444-1213

900 Northern Blvd.

Great Neck

516-773-7737

410 Lakeville Rd.

New Hyde Park

516-354-3401

300 Community Dr.

516-562-3023

900 Northern Blvd.

Great Neck

516-773-7737

L.I. Neurosurgical Associates

410 Lakeville Rd.

New Hyde Park

516-354-3401

North Shore

University Hospital

300 Community Dr.

516-562-3062

24 Research Way

East Setauket

631-444-1213

Stony Brook University

Medical Center

Hospital Level 4,

Suite 430

Stony Brook

631-444-1213

120 Mineola Blvd.

516-663-2123

Neurological Surgery, PC

1991 Marcus Ave.

Lake Success

516-442-2250

North Shore

University Hosp.

300 Community Dr.

516-562-3021

How they were picked

Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.