Adult brainstem gliomas - retrospective analysis of 51 patients

Abstract

ABSTRACTthe specific pathology all BSG must be considered malignant because their localization itself is inoperable (23). These tumors are most often localized in pons, often with infiltration in other regions of the brainstem (16). They characteristically present with multiple cranial nerve deficits, ataxia and long tract dysfunction (5,6,10). The simplest classification of BSG is into two groups as focal and diffuse (4,8). More complex grading system defined subtypes of tumors of the brainstem, according to localization, the presence of hydrocephalus and hemorrhage and growth model (5,7,11,13).umors of the central nervous system are present in about 2% compared to all malignant tumors of the human population. They represent the leading cause of death from malignant tumors in children population and fourth in the adult population (21). In the period before computed tomography (CT) and magnetic resonance imaging (MRI), all brainstem gliomas (BSG) were considered a pathological entity with a poor prognosis. Matson emphasized that regardless of RESUlTS:Of the 51 patients, 62.7% were male and 37.3% were female. The mean age was 30.6±19.3 years. High grade glioma (Astrocytoma grade III and IV) was most common at the age of 38.2±17.9 years (t=.481, p=0.017) while low grade glioma (Astrocytoma grade I and II) was common in younger age as 25.4±17.4 years (X 2 =4.013; p=0.045), with localization in the pons (X 2 =5.299; p=0.021) and exophytic presentation (X 2 =3.862; p=0.049). Ataxia, as initial symptom, was a predictor of poor outcome (HR:5.546, p=0.012).CONClUSION: Due to its specific localization, BSG present a major challenge for neurosurgery, because of the necessity of safe approach for radical resection. Histological verification of BSG determines the need for additional therapeutic procedures such as radiotherapy and chemotherapy. Benefit from correct diagnosis is reflected in the avoidance of potentially adverse effects of treatment.

Brainstem glioma: Prediction of histopathologic grade based on conventional MR imaging

“…However, a previous study of 51 adult BSG patients showed that low-grade tumor was associated with pontine involvement. 5 Our results are consistent with some previous reports that indicate intra-tumoral necrosis (due to elevated level of lactate metabolite in tumor tissue) is associated with higher-grade tumors and/or worse prognosis. 12,21 In 48 diffuse BSGs in adults, necrosis on MRI, histological grading, and duration of symptoms were determined as significant predictors for unfavorable outcome.…”

“…However, a previous study of 51 adult BSG patients showed that low-grade tumor was associated with pontine involvement. 5…”

“…4 Brainstem tumors encompass a heterogeneous group of tumors and although different grading systems (e.g. based on localization and tumor growth pattern) have been proposed, 5 historically they are categorized as low-grade (slow-growing) and high-grade (wore prognosis and rapidly progressive) gliomas based on World Health Organization (WHO) classification. 6 The WHO classification of gliomas is the widely accepted system.…”

“…On MRI, BSGs are visualized as diffuse enlargement of the brainstem and characterized by low-signal intensity on T1-weighted (T1W) and high-signal intensity on T2W images, and variable contrast enhancement as diffuse BSGs usually do not enhance. 5,12 Sometimes a ventral exophytic pattern is seen in pontine lesions. 2 BSGs can be confined to the midbrain or extend to adjacent structures such as the hypothalamus and spinal cord.…”

The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma

“…And in adult HGBSG group, there were no difference between GTR and non-GTR group (P=0.67). Most clinical studies for adult patients with BSG included few patients treated with surgical resection (range from 0-14%) ( 21 , 22 , 31 ). A cohort with 16 consecutive adult patients treated with surgical resection, 2 of which achieved GTR, concluded that the surgical resection was of questionable benefits for adult patients ( 32 ).…”