Introduction: Brain tumors are the most common solid tumors in pediatric patients. Their histological classification remains complex, with high-grade tumors often classified as embryonal or glial. High-grade glial tumors, particularly glioblastomas, are among the most aggressive. Glioblastoma, typically an adult tumor, is much rarer in pediatrics, with an incidence 100 times lower than in adults.

Methods: We report a surgical series of 18 children under 16 years of age treated for glioblastoma at the neurosurgery department of the National Institute of Neurology between January 2009 and December 2017.

Results: The mean age of our patients was 11.22 years, ranging from 16 months to 16 years. Ten patients were male, with a male-to-female ratio of 1.8:1. One patient had neurofibromatosis type1, and one patient had mucopolysaccharidosis. The average time from symptom onset to presentation was 5 weeks. Clinical symptoms predominantly included signs of increased intracranial pressure, sometimes associated with deficits or seizures in 15 patients. Other clinical signs included motor deficits in 5 cases and seizures in 5 patients. Imaging revealed supratentorial lesions in 13 patients (including 4 involving the basal ganglia) and infratentorial lesions in 5 patients (including 3 involving the brainstem). Two patients underwent emergency surgery due to intratumoral bleeding. Open surgery was performed in 94.44% of cases, with three patients undergoing stereotactic biopsy. All other patients underwent surgery for maximal possible resection. Following histopathological examination, all patients were recommended for radiotherapy, with 12 undergoing treatment. Thirteen patients experienced tumor recurrence within 6 to 12 weeks, with three requiring repeat surgery. All patients succumbed within 6 to 13 months, except for two lost to follow-up after 6 and 8 months without recurrence, and three without recurrence after 16 to 48 months of follow-up.

Conclusions: Despite significant progress in understanding and treating various pediatric brain tumors, glioblastoma remains a challenge. Therapeutic advances for these tumors have been limited despite numerous clinical trials combining surgery, radiotherapy, chemotherapy, and the recent development of targeted therapies. Genetic and molecular research remains a battleground for glioblastoma research.