Selection of a management strategy for pediatric brainstem tumors

Abstract

Brainstem tumors arise in portions of the rhombencephalon and mesencephalon. Some authorities include diencephalic tumors in this group. We have reviewed our clinical experience of 69 children (less than 21 years of age) with brainstem tumors evaluated and treated at Duke University Medical Center (DUMC) from 1960 to 1986. There were 19 patients with group 1 tumors (thalamus, third ventricle region, or midbrain) and 50 with group II tumors (pons, medulla oblongata). The common presenting signs and symptoms were ataxia, headache, motor loss, and cranial nerve palsies. The most commonly employed diagnostic imaging studies were air examinations and CT. Preradiotherapy confirmation of malignancy was obtained in five group I patients (astrocytoma, 4; germinoma, 1) and 8 group II patients (astrocytoma, 3; anaplastic astrocytoma, 2; glioblastoma multiforme, 3). All patients received radiotherapy. The 5-year survival rate for the entire population was 40%. The survival rate for group I patients was significantly better than that observed for group II patients. In the 50 group II patients neither patient sex nor age nor presence of cranial nerve palsies nor pretreatment CT scan findings nor field size influenced survival. A long duration of symptoms positively influenced survival. The vast majority of tumor recurrences were within the radiation field. Half of the patients had either stable or improved Karnofsky status 6 months following completion of irradiation. The management strategy for childhood brainstem tumors is discussed.

Apparent Diffusion and Fractional Anisotropy of Diffuse Intrinsic Brain Stem Gliomas

“…2,[20][21][22] These tumors are considered inoperable due to their location, regardless of their histology, and carry the worst prognosis of tumors in pediatric neuro-oncology. Conventional treatment for this disease is radiation therapy, which a ADC decreased and FA increased significantly between baseline and the early post-RT period.…”

Predominance of Pilocytic Histology in Dorsally Exophytic Brain Stem Tumors

“…Brain stem tumors are uniquely identified by anatomic location in trating lesions of the pons, the characteristic clinical and MRI appearance generally obviates the need for histologic confirmation. Even when biopsies are obtained, they are of limited prognostic value; these lesions almost uniform ly show a malignant clinical course with little suggestion of more favorable outcome in the 33-83% of such cases which demonstrate low-grade histology [2,[4][5][6][7], Dorsally exophytic brain stem gliomas (DEBSGs) have been identified as minimally invasive tumors generally associated with prolonged survival [8], Although these lesions have been reported to be 'low-grade' astrocytic tumors, their histology has not been well characterized. The exophytic nature of these lesions and their 'lowgrade' histology suggest the potential benefit of primary surgical intervention [3].…”

Brain stem glioma in a child: False diagnosis of radiation necrosis with FDG PET

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Brainstem gliomas constitute 10-20% of all pediatric central nervous system tumors, and are diagnosed using computed tomography (CT) and magnetic resonance imaging (MRI) with surgical biopsy infrequently performed [1]. One clinical problem that is difficult to resolve in the treatment of brainstem gliomas is the clinical deterioration seen following completion of fractionated radiation therapy.

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