Diffuse Brainstem Tumors: When is a Biopsy Necessary?

Al, Albright

doi:10.1159/000121047

Cited by 42 publications

(42 citation statements)

References 18 publications

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“…In the present study, the success rate for the procedure was 93.7%, which is in agreement with previously published data showing that this rate varies from 87 to 100% [5,6,[10][11][12][13] . Furthermore, the present study verified a higher rate of diagnosis in patients submitted to the transfrontal approach than in those submitted to the suboccipital approach (95.1 vs. 84.2%); however, the difference observed was not statistically significant.…”

Section: Discussionsupporting

confidence: 93%

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Dellaretti¹,

Reyns

Touzet

et al. 2012

Stereotact Funct Neurosurg

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Background: An important aspect of evaluating patients submitted to stereotactic biopsy of the brainstem is the trajectory used. The literature describes two principal approaches: the suboccipital transcerebellar and the transfrontal; however, no studies exist comparing these two techniques. Objective: The purpose of this study was to compare diagnosis success rates and complications between the suboccipital transcerebellar and transfrontal trajectories. Methods: The study evaluated 142 patients submitted to stereotactic biopsy. The patients presented brainstem tumors in the following areas: pons (n = 31), midbrain (n = 36), medulla (n = 2), pons-medulla (n = 30), pons-midbrain (n = 33), and midbrain-pons-medulla (n = 10). On 123 patients, the transfrontal approach was used, and on 19 the suboccipital transcerebellar approach. Results: Comparing success rates between the two approaches, it was observed that in the group of patients submitted to the transfrontal approach, 95.1% (117 cases) were successful, while in those submitted to the suboccipital transcerebellar approach, 84.2% (16 cases) were successful. Despite a higher success rate among patients in the first group, the difference was not statistically significant. Regarding complications, in patients who were biopsied via the transfrontal trajectory, the morbidity rate was 9.8% (12 cases), while in patients submitted to the suboccipital transcerebellar approach, the morbidity rate was 5.3% (1 case) and the mortality rate 5.3% (1 case). Conclusions: This study verified a higher diagnosis rate in patients submitted to the transfrontal approach than in those submitted to the suboccipital transcerebellar approach (95.1 vs. 84.2%); however, the difference was not statistically significant. Regarding complications, the rate was similar in both groups of patients.

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Section: Discussionsupporting

confidence: 93%

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Dellaretti¹,

Reyns

Touzet

et al. 2012

Stereotact Funct Neurosurg

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“…Most authors regard biopsy procedures for intrinsic brainstem tumors as being too dangerous and consider imaging methods as sufficiently reliable. 1,5 Thus, the impact of MRI findings on treatment decisions for brainstem tumors is very high, but the accuracy of MRI-based diagnosis of diffuse brainstem gliomas has not been fully verified by histopathological findings. 8 Thus, some authors have reported that all diffuse brainstem gliomas located above the medulla behave as high-grade astrocytomas, and histological grade is not a significant factor for the survival of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…8 Thus, some authors have reported that all diffuse brainstem gliomas located above the medulla behave as high-grade astrocytomas, and histological grade is not a significant factor for the survival of these patients. 1,4,5,18,20 Few studies have been conducted concerning prognosis and prognostic factors in brainstem gliomas. 1 This may be due to the low incidence of these tumors and the fact that histopathological diagnosis is rarely confirmed.…”

Section: Discussionmentioning

confidence: 99%

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Diffuse brainstem glioma: prognostic factors

Dellaretti

Reyns

Touzet

et al. 2012

JNS

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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.

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“…As stated previously, these gliomas are typically malignant fibrillary astrocytomas which infiltrate along the white matter tracts into the midbrain and thalamus. They invariably have a rapidly progressive and dismal course, similar to the clinical course for glioblastoma multiforme in the brain [3, 55]. There is no role for radical surgery or biopsy since the tumor histology does not change the treatment strategy [56].…”

Section: Future Directionsmentioning

confidence: 99%

Brainstem Tumors: Where Are We Today?

Recinos

Sciubba

Jallo³

2007

Pediatr Neurosurg

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Brainstem tumors comprise 10–20% of all pediatric central nervous system tumors. The management of these tumors has evolved dramatically in the past century. Once considered uniformly fatal, it is now known that brainstem tumors have distinguishing characteristics and do not behave identically. The focality and location of the lesion is determined from the clinical history, presentation, and associated imaging. Based on these findings, it is possible to predict the behavior of the tumor and choose an appropriate intervention. Focal lesions have a good prognosis and are treated operatively while diffuse lesions have a poor prognosis and are managed medically. This article reviews the current classification of brainstem tumors, current management options and future directions for the treatment of these rare tumors.

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Diffuse Brainstem Tumors: When is a Biopsy Necessary?

Cited by 42 publications

References 18 publications

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Diffuse brainstem glioma: prognostic factors

Brainstem Tumors: Where Are We Today?

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