Follow-Up Study of Brain Stem Tumors in Children

Villani, Robert; Gaini, S. M.; Tomei, G.

doi:10.1159/000119561

Cited by 21 publications

(13 citation statements)

References 8 publications

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“…The classic presentation is rapidly progressive brain stem dysfunction -usually multiple, long tract cranial nerve and cerebellar dysfunction -in a child aged 5-8 years [32], The sixth and seventh cranial nerves are most often involved, and in 70% of cases the involvements are mul tiple and/or bilateral. The age of onset, clinical presen tation, and the amount of brain stem involvement is quite variable [1,3,6,10,13,14,17,18,29,36,38,39,41,[45][46][47][48]50]. Adolescents and adults are more likely to present with a slower onset of symptoms and more iso lated brain stem dysfunction.…”

Section: Clinical Featuresmentioning

confidence: 99%

Current Management of Brain Stem Gliomas

Edwards¹,

Prados²

1987

Pediatr Neurosurg

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Brain stem gliomas constitute 10–20% of central nervous system tumors in children. Management of these tumors remains controversial. In general, the prognosis for long-term survival is poor, but brain stem gliomas represent a heterogeneous population of tumors, some of which have a better prognosis than others. Improvements in diagnostic imaging techniques, particularly the availability of magnetic resonance imaging, provide the means to differentiate among these populations. Advances in radiation therapy may provide the means to improve survival. In this article we review the reported series and the present state of the art for the diagnosis and management of children with brain stem gliomas.

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Section: Clinical Featuresmentioning

confidence: 99%

Current Management of Brain Stem Gliomas

Edwards¹,

Prados²

1987

Pediatr Neurosurg

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“…Historically, this classification has referred to a stereotypical clinicopathological entity, namely, that of a high-grade infiltrative glial neoplasm sit uated in the pons. The children harboring these tumors most often present with a short clinical history of multi ple, bilateral cranial neuropathies, as well as a variable degree of motor and/or sensory abnormalities [5,[11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…In the setting of this stereotypical picture, most clini cians now oppose a diagnostic biopsy procedure. The nat ural history is one of a steady progression to death, with median survival reported between 4 and 15 months, and overall 5-year survival rates approaching 30% [8,11,23,[29][30][31], However, it has become evident, from variations in survival rates, that brainstem neoplasms are a heteroge neous group of tumors. Moreover, it is now possible to classify these lesions based on their clinical course, neuroradiologic features, and associated neurological examina tions.…”

Section: Introductionmentioning

confidence: 99%

Intra-Axial Tumors of the Cervicomedullary Junction: Surgical Results and Long-Term Outcome

et al. 1997

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Until recently, intra-axial brainstem tumors were traditionally regarded as surgically inaccessible lesions with a uniformly poor prognosis. However, increasing data indicate that distinct subgroups of brainstem tumors exist that are amenable to surgical intervention. To address this question, we reviewed our experience in the operative management of 39 consecutive patients, in the magnetic resonance imaging (MRI) era, with intra-axial cervicomedullary tumors, in order to determine those factors associated with long-term outcome. Thirty-nine patients (26 male, 13 female) underwent surgery by a single surgeon (F.J.E.) between 1985 and 1994. Mean age of diagnosis was 14 years (range 3 months – 60 years); mean duration of preoperative symptoms was 24 weeks (range 1–168). Twenty patients presented with lower cranial nerve dysfunction and 19 presented with motor and/or sensory dysfunction. All patients were graded according to the McCormick Scale, pre- and postoperatively, and at the time of follow-up. All patients were evaluated with MRI scanning. Twenty-three patients had either previous biopsy or subtotal resection, 13 previous radiation therapy, and 6 previous chemotherapy. The mean time to follow-up was 48 months (range 7–138). Twelve patients underwent gross total resection, 7 near total resection (>90%), 15 subtotal resection (50–90%), and 5 partial resection (< 50%). Histologically, there were 15 low-grade fibrillary astrocytomas, 9 ependymomas, 7 gangliogliomas, 3 anaplastic astrocytomas, 3 juvenile pilocytic astrocytomas, and 2 mixed gliomas. Although the vast majority of tumors were low grade histologically, a higher proportion of the patients with high-grade lesions experienced tumor progression when compared to low-grade tumors (75 vs. 30%). Overall, the 5-year progression-free and total survivals were 60 and 89%, respectively. There was 1 death within the first postoperative month. Preoperative duration of symptoms greater than 15 weeks was associated with a longer progression-free survival. There was a trend for preoperative neurologic grade to predict functional neurologic outcome at follow-up. In summary, intra-axial tumors of the cervicomedullary junction are a distinct subset of brainstem tumors, predominantly of low-grade histology, with favorable long-term progression-free and total survivals following surgical resection. A long duration of preoperative symptoms may indicate an indolent clinical course and a more favorable prognosis. Our data also indicate that early surgical intervention is warranted prior to neurologic deterioration.

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“…Although many authors agree in principle to the surgery of brain stem lesions for diagnostic and therapeutic purposes, the choice of sur gical approach and the extent of resection remain controversial [1,[4][5][6][7]. Stereotactic biopsy and aspiration techniques with CT guidance and multiplanar image reformation now permit the safe, accurate, and reliable diagnosis of intra-axial brainstem lesions with acceptable op erative and anesthetic risk [2,3].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Brainstem Mass Lesions by CT-Guided Stereotactic Surgery

Coffey¹,

Lunsford²

1985

Stereotact Funct Neurosurg

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Current neuroradiographic techniques including computed tomographic scanning (CT) and magnetic resonance imaging (MRI) when added to the clinical neurologie examination can localize precisely even small lesions within the brainstem. While the clinical-radiographic diagnosis is accurate with respect to locale, it is often in error with respect to the pathologic nature of the solitary brainstem lesion. Therefore, empiric treatment without the benefit of a tissue diagnosis will often be inappropriate. CT-guided stereotactic surgery can safely and reliably provide a tissue diagnosis in such cases. Furthermore, in selected cases, therapeutic interventions can be of substantial and lasting benefit to the patient.

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Follow-Up Study of Brain Stem Tumors in Children

Cited by 21 publications

References 8 publications

Current Management of Brain Stem Gliomas

Current Management of Brain Stem Gliomas

Intra-Axial Tumors of the Cervicomedullary Junction: Surgical Results and Long-Term Outcome

Diagnosis and Treatment of Brainstem Mass Lesions by CT-Guided Stereotactic Surgery

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