Prognosis of 26 children with intracranial germ-cell tumors (17 germinomas and 9 teratomas) treated in a 10 year period is reported from the University Hospital Hamburg-Eppendorf, Germany. Median age at diagnosis was 11.5 years (range 1.5-16.8 years). Tumor location was in the pineal region in 69% and suprasellar/hypothalamic in 31%. Symptoms were increased intracranial pressure, Parinaud’s syndrome, and endocrine deficits. Surgical resection was attempted in 22 patients, 25 were irradiated, and 8 received additional chemotherapy. Long-term survival rate was 88% for germinomas and 43% for malignant teratomas; 57% had no and 37% had mild neurologic deficits, and 24% had neuro-endocrine dysfunction. Neuropsychological function was normal or only mildly impaired in 53%, and 69% had no change in their level of education. [1]
COMMENT. In this center, primary intracranial germ-cell tumors (PGCT) accounted for 8.5% of childhood brain tumors, while other series report a frequency of less than 5%. Germinomas arising in the pineal or suprasellar region are the most common form (65%) of PGCT and have a good prognosis, with 88% long-term survival after surgical removal and radiation. Severe residual complications, including cognitive deficits, are uncommon, despite post-operative craniospinal axis irradiation. Malignant teratomas have a less favorable prognosis. The younger age at which medulloblastomas are treated with irradiation accounts for the higher incidence of cognitive deficits in these tumor patients.