Correlation among magnetic resonance imaging findings, prognostic factors for survival, and histological diagnosis of intrinsic brainstem lesions in children

Dellaretti, Marcos; Touzet, Gustavo; Reyns, Nicolas; Dubois, François; Gusmão, Sebastião; Pereira, Jorge Luís Gavina; Blond, S.

doi:10.3171/2011.9.peds1167

Cited by 44 publications

(34 citation statements)

References 20 publications

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“…High-grade pathology (WHO Grade III/IV) has been consistently found to be a predictor of disease progression and death, whereas patients with pilocytic astrocytomas have the most favorable prognosis. 6,12,16,18,20,27 Fisher et al 12 found that pontine location, engulfment of the basilar artery, symptom duration less than 6 months, fibrillary pathology, and abducens nerve palsy on presentation were all associated with worse survival. At 5 years, the survival of patients with pilocytic astrocytoma was 95%, compared with a dismal 15% for patients with fibrillary astrocytomas; however, the researchers did not differentiate focal and diffuse tumors within their patient population and also combined WHO Grade II–IV tumors as fibrillary astrocytomas.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging and other imaging techniques such as spectroscopy, perfusion, and PET are performed in an attempt to predict the histology of focal brainstem lesions, but a stereotactic biopsy is necessary to distinguish a focal low-grade tumor from a focal malignant tumor and can be conducted with low morbidity. 6,14,17,22 Many investigators have advocated resection as the primary treatment for focal brainstem tumors. 3,9,11,15,16,18,20,21,23,24,27 Some researchers have found that the extent of resection is an important prognostic factor for survival, contrary to our findings.…”

Section: Discussionmentioning

confidence: 99%

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Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Klimo

Panandiker²,

Thompson

et al. 2013

PED

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Object Whereas diffuse intrinsic pontine gliomas generally have a short symptom duration and more cranial nerve involvement, focal brainstem gliomas are commonly low grade, with fewer cranial neuropathies. Although these phenotypic distinctions are not absolute predictors of outcome, they do demonstrate correlation in most cases. Because there is a limited literature on focal brainstem gliomas in pediatric patients, the objective of this paper was to report the management and outcome of these tumors. Methods The authors reviewed the records of all children diagnosed with radiographically confirmed low-grade focal brainstem gliomas from 1986 to 2010. Each patient underwent biopsy or resection for tissue diagnosis. Event-free survival (EFS) and overall survival were evaluated. Univariate analysis was conducted to identify demographic and treatment variables that may affect EFS. Results Fifty-two patients (20 girls, 32 boys) with follow-up data were identified. Median follow-up was 10.0 years, and the median age at diagnosis was 6.5 years (range 1–17 years). The tumor locations were midbrain (n = 22, 42%), pons (n = 15, 29%), and medulla (n = 15, 29%). Surgical extirpation was the primary treatment in 25 patients (48%). The 5- and 10-year EFS and overall survival were 59%/98% and 52%/90%, respectively. An event or treatment failure occurred in 24 patients (46%), including 5 deaths. Median time to treatment failure was 3.4 years. Disease progression in the other 19 patients transpired within 25.1 months of diagnosis. Thirteen of these patients received radiation, including 11 within 2 months of primary treatment failure. Although children with intrinsic tumors had slightly better EFS at 5 years compared with those with exophytic tumors (p = 0.054), this difference was not significant at 10 years (p = 0.147). No other variables were predictive of EFS. Conclusions Surgery suffices in many children with low-grade focal brainstem gliomas. Radiation treatment is often reserved for disease progression but offers comparable disease control following biopsy. In the authors' experience, combining an assessment of clinical course, imaging, and tumor biopsy yields a reasonable model for managing children with focal brainstem tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Klimo

Panandiker²,

Thompson

et al. 2013

PED

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“…The differential diagnosis of brainstem lesions in children includes neoplastic, vascular, infectious and postinfectious causes1 2 This case highlights that it is important to include high-grade glioma in the differential of acute brainstem haemorrhage and the essential role of biopsy in establishing the diagnosis.…”

Section: Descriptionmentioning

confidence: 99%

Acute brainstem haemorrhage as a presenting feature of high-grade glioma

Aghajan

Levy

et al. 2016

BMJ Case Reports

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“…[1112131415] Interestingly, our case is unique as he survived for 21 years after histopathological confirmation after diagnosed as brainstem glioma. Prognostic factors affecting survival in the brainstem glioma include age at diagnosis, histopathological type and WHO grade, extent of surgical resection, adjuvant therapy, focal or diffuse lesion, requirement for VP shunt, and associated comorbid illness.…”

Section: Introductionmentioning

confidence: 99%

“…Prognostic factors affecting survival in the brainstem glioma include age at diagnosis, histopathological type and WHO grade, extent of surgical resection, adjuvant therapy, focal or diffuse lesion, requirement for VP shunt, and associated comorbid illness. [1415] Umehara et al . reported a case of pilocytic astrocytoma who received gamma knife therapy 17-years back developed rapid tumor growth during pregnancy necessitating emergency surgery and histopathological diagnosis was pilocytic astrocytoma.…”

Section: Introductionmentioning

confidence: 99%

Pilocytic Midbrain Astrocytoma Presenting with Fresh Bleed after Twenty-one-years Survival Following First Surgery: A Unique Case of Longest Brainstem Glioma Survival

Satyarthee

Sudhan

Mehta

2016

Journal of Neurosciences in Rural Practice

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Brainstem glioma usually carries a poor prognosis and prolonged survival is very infrequent. In a detailed Pubmed, Medline search for prolonged survival, authors could got a longest survival only up to seventeen years, reported by Umehara et al, who was subjected to gamma knife therapy and got symptomatic, MRI brain reveled large tumor growth during pregnancy necessitating emergency surgery and histopathological diagnosis was pilocytic astrocytoma. Authors report an interesting case of midbrain glioma diagnosed 21 years back, who underwent gross resection in the year 1993, histopathology was pilocytic astrocytoma, WHO grade I, and received gamma knife surgery for residual subsequently and he presented with sudden onset left sided hemiplegia on the current admission. The cranial MRI imaging revealed an infarct involving right hemi midbrain, contrast MRI brain revealed no residual glioma. To the best knowledge of authors such prolonged survival is not reported with a case of brainstem glioma survived twenty- one years with non residual tumor on the last imaging study represents first case of its kind in the western literature and probably developed hemiplegia due to bleed, highlighting bleed as delayed complication following gamma knife therapy for cranial tumors

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Correlation among magnetic resonance imaging findings, prognostic factors for survival, and histological diagnosis of intrinsic brainstem lesions in children

Cited by 44 publications

References 20 publications

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Acute brainstem haemorrhage as a presenting feature of high-grade glioma

Pilocytic Midbrain Astrocytoma Presenting with Fresh Bleed after Twenty-one-years Survival Following First Surgery: A Unique Case of Longest Brainstem Glioma Survival

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