Incidental Brain Tumors in the Pediatric Population: A Systematic Review and Reappraisal of Literature

Fareed Jumah, Michael S. Rallo, Travis Quinoa, Bharath Raju, Vinayak Narayan, Gaurav Gupta, Anil Nanda

Research output: Contribution to journalReview articlepeer-review


Objectives: Management of incidental asymptomatic brain tumors in children is controversial due to lack of clear evidence-based guidelines. We present this systematic review in an attempt to highlight an optimal treatment paradigm. Methods: This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases were searched up to August 2019 using the keywords “incidental,” “brain tumor,” and “pediatric.” Our main focus was on brain lesions suspected for neoplasm, diagnosed incidentally on neuroimaging in an otherwise asymptomatic patient <18 years old. Cystic, vascular, and inflammatory brain lesions were excluded. Results: Fourteen studies comprising 308 patients were included. All cases were diagnosed using magnetic resonance imaging. The most common indications for imaging were headache (93; 30%) and trauma (72; 23%). Lesion distribution was supratentorial (179; 58%), infratentorial (121; 40%), and intraventricular (8; 3%). Of 308 cases, 243 (79%) were managed with neuroradiological surveillance and 57 (19%) by upfront surgical excision. Of those managed conservatively, 177 (73%) remained stable within a mean follow-up of 30 months, 54 (22%) progressed, and 12 (5%) spontaneously regressed. Meanwhile, upfront excision achieved complete remission in all 57 cases over a mean follow-up of 68.3 months. Conclusion: A small body of evidence has emerged, highlighting the marked heterogeneity and contradictory results between the available studies, limiting our ability to draw solid conclusions. At this point, the decision between surgery and “watchful waiting” should be tailored on an individual patient basis depending on suspicion of malignancy, clinical or radiologic progression, and parental preference.

Original languageEnglish (US)
Pages (from-to)121-131
Number of pages11
JournalWorld Neurosurgery
StatePublished - Jul 2020

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Surgery


  • Brain tumor
  • Incidental
  • Management
  • Pediatric
  • Systematic review


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