SYNOPSIS Astrocytomas of the pons and medulla oblongata ('brain-stem gliomas') while often invasive locally, do not as a rule seed and metastasize along the spinal meninges. Three cases are here reported (two adults, one child) in whom astrocytoma of the brain-stem metastasized along the spinal cord. The dura mater itself and the spinal epidural space were invaded in two cases. The child and one adult had a pontine astrocytoma, the other adult's tumour originated in the medulla oblongata. In the two cases that came to necropsy the tumour of the brain-stem was much better differentiated than the meningeal deposits. These three cases suggest that the possibility of spinal spread of brain-stem gliomas should be considered when dealing with diagnostic and therapeutic problems of such patients.Dissemination of neuroectodermal tumours through cerebrospinal fluid pathways was first observed in medulloblastomas and this had been the only such tumour known to metastasize with any frequency until Russell and Cairns (1930) reported a case of spinal metastases from a fibrillary astrocytoma of the thalamus. This report was soon followed by similar observations by the same authors (Cairns and Russell, 1931) and others that have included gliomas of every type, originating from various parts of the brain (Polmeteer and Kernohan, 1947) and even the spinal cord itself (Roth and Elvidge, 1960). Curiously, astrocytomas of the pons and medulla oblongata, the so-called brain-stem gliomas, malignant and devastating as they may be in their area of origin, do not as a rule metastasize to the spinal subarachnoid space and the cauda equina.We report three cases of brain-stem gliomas (astrocytomas), two from the pons and one from the medulla oblongata, that have seeded extensively through the spinal subarachnoid pathways with corresponding symptomatology.
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