Diffuse brainstem glioma: prognostic factors

Abstract

Object Brainstem gliomas were regarded as a single entity prior to the advent of MRI; however, several studies investigating MRI have recognized that these lesions are a heterogeneous group, and certain subgroups have a better prognosis for long-term survival. The aim of this study was to conduct a retrospective analysis of prognostic factors of patients with brainstem gliomas confirmed by histopathological diagnosis, particularly regarding assessment of whether histological grade, age, and MRI findings are prognostic factors for patient survival. Methods The study evaluated 100 patients diagnosed with brainstem glioma. There were 63 adults (40 men and 23 women; age range 18–75 years, mean 41 years) and 37 children (19 boys and 18 girls; age range 2–12 years, mean 6.9 years). Results The mean overall survival of this population, measured from the date of biopsy, was 57 months for diffuse low-grade glioma and 13.8 months for diffuse high-grade glioma (p < 0.001). The mean survival among patients with nonenhancing contrast lesions on MRI was 54.2 months, whereas for patients with enhancing lesions, it was 21.7 months (p < 0.001). Comparisons between the Kaplan-Meier survival curves of adults and children revealed similar median survival periods of 25 and 16 months, respectively (p > 0.05). The multivariate analysis (Cox proportional hazards regression) revealed that only histological grade was a significant prognostic factor (p < 0.001). Conclusions The study revealed that histological grade and MRI features were significant prognostic factors for survival in these patients, but in multivariate analysis, only histological grade remained a significant factor.

Robot-assisted stereotactic brain biopsy: systematic review and bibliometric analysis

“…Six studies reported use of the ROSA robot [13–18] and two the Neuromate robot [12, 19]; the other robots used were the Puma 200 robot [2], Renaissance robot [20], Minerva robot (Swiss Federal Institute of Technology of Lausanne, Switzerland) [21], MKM robot (Zeiss, Oberkochen, Germany) [22], Surgiscope robot (ISIS, Grenoble, France) [23], iSYS1 robot (iSYS, Kitzbühel, Austria) [24], and RONNA G3 robot (University of Zagreb, Croatia) [25]. The size and configuration of the reported devices varied significantly with the ROSA and Neuromate robots, occupying a large footprint and weighing up to 200 kg, and the Renaissance and iSYS1 robots being small enough to fix directly to the patient’s head and Mayfield clamp respectively, and weighing as little as 1.4 kg [20, 24].…”

“…Dellaretti et al compared transcortical and transcerebellar approaches in patients undergoing brainstem biopsy and did not find any significant difference in outcomes [12]. Nonetheless, given that there is no systematic or objective means of trajectory planning at present, this remains a significant confounding factor.…”

Can Multiparametric MRI and FDG-PET Predict Outcome in Diffuse Brainstem Glioma? A Report from a Prospective Phase-II Study

“…The sensitivity and specificity for correctly diagnosing low-grade gliomas were quite low with all MR sequences. Multiple studies have tried to establish the role of various MR sequences in predicting survival [20,21,22]. In a large cohort of 100 patients who underwent standard MRI, Dellaretti et al [22] found that in patients assessed by MRI with and without contrast enhancement, mean survival times were 21.7 and 54.2 months, respectively (p < 0.001).…”

“…Multiple studies have tried to establish the role of various MR sequences in predicting survival [20,21,22]. In a large cohort of 100 patients who underwent standard MRI, Dellaretti et al [22] found that in patients assessed by MRI with and without contrast enhancement, mean survival times were 21.7 and 54.2 months, respectively (p < 0.001). In a retrospective study, Yamasaki et al [19] showed that clinical and conventional MR findings at presentation were not predictive of survival, although lactate elevation on MRS was a prognostic factor in DIPG patients.…”

“…Therefore, in recent years, the main focus of research has shifted to prognosticate DIPG using novel radiological and functional imaging tools [19,20,21,22]. Several study groups are not only attempting to prognosticate DIPG by imaging, immunocytochemistry and genetic analysis, they are also trying to identify novel therapeutic targets [23,24,25,26,27,28] that may help in providing further information regarding response to therapy and enable the development of more rational drug treatment.…”