Brainstem Tumors: Where Are We Today?

Recinos, Pablo F.; Sciubba, Daniel M.; Jallo, George I.

doi:10.1159/000098831

Cited by 95 publications

(64 citation statements)

References 125 publications

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“…For these lesions, many pediatric neurosurgeons seem to dispute the value of histological verification due to the risk of complications and inconsistent WHO grading in different parts of the tumor. 4,15 In recent years, several authors have advocated taking biopsy specimens because histological entities other than glioma may be encountered. 16,17 In contrast to the well-known pontine gliomas of childhood, some of the tumors in the midbrain are localized.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients

Lundar¹,

Due-Tønnessen²,

Egge³

et al. 2014

PED

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Object The authors delineate the long-term results of surgical treatment for pediatric low-grade midbrain glioma. Methods A series of 15 consecutive patients (age range 0–15 years) who underwent primary tumor resection for a low-grade midbrain glioma during the years 1989–2010 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily living were scored according to the Barthel Index. Results Of the 15 patients, 10 were in their 1st decade (age 0–9 years) and 5 were in their 2nd decade of life (age 10–15 years) at the time of surgery. The male/female ratio was 0.50 (5:10). No patients were lost to follow-up. One patient died in the postoperative period (32 days posttreatment). Another 2 patients died during follow-up. One patient succumbed to acute bleeding in the resection cavity 8 months after surgery, and the other died of shunt failure 21 years after initial treatment. Twelve patients are alive at the time of this writing, with follow-up periods from 3 to 24 years (median 8 years). Among the 12 survivors, the Barthel Index scores were normal (100) in 11 patients and 80 in 1 patient. A total of 25 tumor resections were performed. In 1 patient, further resection was performed 5 days after initial resection due to MRI-confirmed residual tumor. Another 5 patients underwent repeat tumor resection after MRI-confirmed progressive tumor disease and clinical deterioration ranging from 3 months to 4 years after the initial operation. Three of these 5 patients also underwent a third resection, and 1 of the 3 underwent a fourth operation. Six children received adjuvant therapy: local radiotherapy in 2 patients, chemotherapy in 3 patients, and both in 1 patient. Twelve (80%) of the 15 patients needed treatment for persistent hydrocephalus. Conclusions Selected cases of low-grade midbrain gliomas may clearly benefit from resection with favorable results, even for prolonged periods. Three patients in the present series died, one of whom had a prolonged survival period of 21 years. Among the 12 survivors, stable long-term results appeared obtainable in at least 9. One patient died of acute hemorrhage 8 months after initial resection; otherwise, rapid tumor progression and death were not observed. Forty percent of the patients received adjuvant treatment, with local radiotherapy, chemotherapy, or both.

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Section: Discussionmentioning

confidence: 99%

Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients

Lundar¹,

Due-Tønnessen²,

Egge³

et al. 2014

PED

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“…Although this intrinsically makes sense -the fewer the symptoms, the less aggressive or advanced the disease -extrapolating these findings to children must be done with caution, because a disproportionate number of paediatric lesions tend to be brainstem tumours that, though usually low-grade and non-epileptogenic, often are non-resectable because of their location and proximity to function-rich neural tissue [2,3,[137][138][139]. Nonetheless, especially among supratentorial lesions, it makes sense that having seizures present before all other symptoms develop is a hopeful prognostic sign, given that low-grade gliomas and other so-called benign lesions tend to be associated with much higher seizure rates than high-grade lesions [32,87,91,113,140,141].…”

Section: Implications Of Brain-tumour Induced Seizuresmentioning

confidence: 99%

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

Ranger¹,

Diosy²

2015

Molecular Considerations and Evolving Surgical Management Issues in the Treatment of Patients With a Brain Tumor

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“…Stereotactic biopsy has been reported to provide the diagnosis with minimal morbidity (Packer 2000). Although glucocorticoids and irradiation may temporarily improve symptoms, there seems to be no long-term benefit (Recinos et al 2007). Occasionally, mixed gliomas may occur, for which temozolomide, an oral derivative of dacarbazine, may be useful therapy.…”

Section: Malignant Tumours Of the Parasellar Regionmentioning

confidence: 99%

The diagnosis and management of parasellar tumours of the pituitary

Kaltsas

Evanson²,

Chrisoulidou³

et al. 2008

Endocrine Related Cancer

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The sellar and parasellar region is an anatomically complex area where a number of neoplastic, inflammatory, infectious, developmental and vascular diseases can develop. Although most sellar lesions are due to pituitary adenomas, a number of other pathologies involving the parasellar region can present in a similar manner. The diagnosis of such lesions involves a multidisciplinary approach, and detailed endocrinological, ophthalmological, neuroimaging, neurological and finally histological studies are required. Correct diagnosis prior to any intervention is essential as the treatment of choice will be different for each disorder, particularly in the case of primary malignant parasellar tumours. The complexity of structures that define the parasellar region can produce a variety of neoplastic processes, the malignant potential of which relies on histological grading. In the majority of parasellar tumours, a multimodal therapeutic approach is frequently necessary including surgery, radiotherapy, primary or adjuvant medical treatment and replacement of apparent endocrine deficits. Disease-specific medical therapies are mandatory in order to prevent recurrence or further tumour growth. This is particularly important as neoplastic lesions of the parasellar region tend to recur after prolonged follow-up, even when optimally treated. Apart from the type of treatment, identification of clinical and radiological features that could predict patients with different prognosis seems necessary in order to identify high-risk patients. Due to their rarity, central registration of parasellar tumours is required in order to be able to provide evidence-based diagnostic and mainly therapeutic approaches. Endocrine-Related Cancer (2008) 15 885-903

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Brainstem Tumors: Where Are We Today?

Cited by 95 publications

References 125 publications

Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients

Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

The diagnosis and management of parasellar tumours of the pituitary

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