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brainstem_glioma

Brainstem glioma

Epidemiology

Around 75% of the brainstem gliomas are diagnosed in children and young adults under the age of twenty, but have been known to affect older adults as well.

Brainstem gliomas start in the brain or spinal cord tissue and typically spread throughout the nervous system.

Brainstem gliomas are often primary brain tumors, and rarely metastasize, or spread, to affect another part of the body.

Classification

Diagnosis

Biopsy

Seven patients had a transventricular biopsy of the brainstem performed. Of those, five were pediatric patients. The median age was 10 years (range: 3-26 years). Five of them were female and two male. Four patients presented with secondary obstructive hydrocephalus. The main clinical presentations were intracranial hypertension syndrome in four patients, motor neuron disease in four patients, two with decreased state of alertness, two with gait ataxia, and one with Parinaud syndrome. The types of tumors found in the histopathology and their location were one ventral (pons) and one aqueductal anaplastic astrocytoma, two ventral, one aqueductal, and one attached to the floor of the fourth ventricle pilocytic astrocytoma and one ventral low-grade astrocytoma. The route taken to approach the ventral tumors was made through premammillary fenestration. The tumors of the aqueduct and floor of the fourth ventricle were approached transaqueductally. Conclusion The use of flexible endoscops for biopsy of ventral, dorsal (tectum lamina quadrigemina), and diffuse brainstem tumors is a useful, effective, and safe procedure that also allows to treat obstructive hydrocephalus secondary to the tumors 1).

Treatment

Outcome

Case series

Maxwell et al. used The Surveillance, Epidemiology and End Results (SEER) database to conduct a population based study on pediatric patients with histologically confirmed anaplastic astrocytoma or glioblastoma tumors located within the brainstem. Multivariate analysis incorporating patient demographics, tumor characteristics, and treatments were used to determine predictors of cancer-specific mortality and survival at 6 months, 9 months, 1 year, and 2 years.

They included 154 patients from the SEER database - 72 (47%) anaplastic astrocytoma and 82 (53%) glioblastoma patients. Median survival for the entire cohort was 10.0 months. Glioblastoma histology, developmental stage, and large tumor size were significantly associated with cancer-specific mortality. Six-month, 9-month, 1-year, and 2-year survival rates were 75%, 57%, 42%, and 20%, respectively. Glioblastoma histology was associated with worsened survival at 6 months (OR=0.19, p=0.0081), 9 months (OR=0.18, p< 0.001), 1 year (OR=0.19, p< 0.001), and 2 years (OR=0.14, p=0.0055). Radiation therapy was associated with improved survival at 6 (OR=8.53, p=0.0012) and 9 months (OR=3.58, p=0.035) but not at 1 or 2 years. Radiation therapy was associated with improved survival in glioblastoma (9.0 vs. 3.0 months, p< 0.001).

This population-based study demonstrated that glioblastoma histology is associated with a poor prognosis in pediatric patients with brainstem high-grade gliomas. Regardless of histology, radiation therapy improved survival at 6 and 9 months but not long-term. 2).

2015

Seven patients had a transventricular biopsy of the brainstem performed. Of those, five were pediatric patients. The median age was 10 years (range: 3-26 years). Five of them were female and two male. Four patients presented with secondary obstructive hydrocephalus. The main clinical presentations were intracranial hypertension syndrome in four patients, motor neuron disease in four patients, two with decreased state of alertness, two with gait ataxia, and one with Parinaud syndrome. The types of tumors found in the histopathology and their location were one ventral (pons) and one aqueductal anaplastic astrocytoma, two ventral, one aqueductal, and one attached to the floor of the fourth ventricle pilocytic astrocytoma and one ventral low-grade astrocytoma. The route taken to approach the ventral tumors was made through premammillary fenestration. The tumors of the aqueduct and floor of the fourth ventricle were approached transaqueductally.

The use of flexible endoscops for biopsy of ventral, dorsal (tectum lamina quadrigemina), and diffuse brainstem tumors is a useful, effective, and safe procedure that also allows to treat obstructive hydrocephalus secondary to the tumors 3).

1)
Torres Corzo JG, Rodriguez JS, Castillo JL, Escobedo RF, Cervantes D, Della Vecchia RR, Vinas Rios JM. Biopsy of Brainstem Gliomas Using Flexible Endoscopes. J Neurol Surg A Cent Eur Neurosurg. 2015 Mar 23. [Epub ahead of print] PubMed PMID: 25798800.
2)
Maxwell R, Luksik AS, Garzon-Muvdi T, Yang W, Huang J, Bettegowda C, Jallo GI, Terezakis SA, Groves M. Population-based Study Determining Predictors of Cancer-Specific Mortality and Survival in Pediatric High-grade Brainstem Glioma. World Neurosurg. 2018 Aug 20. pii: S1878-8750(18)31827-8. doi: 10.1016/j.wneu.2018.08.044. [Epub ahead of print] PubMed PMID: 30138731.
3)
Torres-Corzo JG, Sanchez-Rodriguez J, Castillo-Rueda JL, Falcon-Escobedo R, Cervantes D, Rodriguez-Della Vecchia R, Vinas-Rios JM. Biopsy of Brainstem Gliomas Using Flexible Endoscopes. J Neurol Surg A Cent Eur Neurosurg. 2015 Jul;76(4):291-7. doi: 10.1055/s-0034-1373661. Epub 2015 Mar 23. PubMed PMID: 25798800.
brainstem_glioma.txt · Last modified: 2019/04/05 17:45 by administrador