Surgical considerations for ′intrinsic′ brainstem gliomas: Proposal of a modification in classification

Mehta, Veer Singh; Chandra, P. Sarat; Singh, Pankaj Kumar; Garg, Ajay; Rath, GK

doi:10.4103/0028-3886.53272

Cited by 27 publications

(11 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,14,17,22 Many investigators have advocated resection as the primary treatment for focal brainstem tumors. 3,9,11,15,16,18,20,21,23,24,27 Some researchers have found that the extent of resection is an important prognostic factor for survival, contrary to our findings. 16,24,25 …”

Section: Discussioncontrasting

confidence: 99%

“…26 Many classification systems have been proposed, incorporating features such as size, location, and imaging characteristics. 1,21,23,26 Epstein and McCleary 8 grouped intrinsic nonexophytic tumors as focal (circumscribed mass > 2 cm in diameter without associated edema), diffuse, or cervicomedullary. Choux et al 5 described 4 types of tumors: Type I, diffuse brainstem gliomas; Type II, focal intrinsic tumors (solid or cystic); Type III, exophytic; and Type IV, cervicomedullary.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Klimo

Panandiker²,

Thompson

et al. 2013

PED

View full text Add to dashboard Cite

Object Whereas diffuse intrinsic pontine gliomas generally have a short symptom duration and more cranial nerve involvement, focal brainstem gliomas are commonly low grade, with fewer cranial neuropathies. Although these phenotypic distinctions are not absolute predictors of outcome, they do demonstrate correlation in most cases. Because there is a limited literature on focal brainstem gliomas in pediatric patients, the objective of this paper was to report the management and outcome of these tumors. Methods The authors reviewed the records of all children diagnosed with radiographically confirmed low-grade focal brainstem gliomas from 1986 to 2010. Each patient underwent biopsy or resection for tissue diagnosis. Event-free survival (EFS) and overall survival were evaluated. Univariate analysis was conducted to identify demographic and treatment variables that may affect EFS. Results Fifty-two patients (20 girls, 32 boys) with follow-up data were identified. Median follow-up was 10.0 years, and the median age at diagnosis was 6.5 years (range 1–17 years). The tumor locations were midbrain (n = 22, 42%), pons (n = 15, 29%), and medulla (n = 15, 29%). Surgical extirpation was the primary treatment in 25 patients (48%). The 5- and 10-year EFS and overall survival were 59%/98% and 52%/90%, respectively. An event or treatment failure occurred in 24 patients (46%), including 5 deaths. Median time to treatment failure was 3.4 years. Disease progression in the other 19 patients transpired within 25.1 months of diagnosis. Thirteen of these patients received radiation, including 11 within 2 months of primary treatment failure. Although children with intrinsic tumors had slightly better EFS at 5 years compared with those with exophytic tumors (p = 0.054), this difference was not significant at 10 years (p = 0.147). No other variables were predictive of EFS. Conclusions Surgery suffices in many children with low-grade focal brainstem gliomas. Radiation treatment is often reserved for disease progression but offers comparable disease control following biopsy. In the authors' experience, combining an assessment of clinical course, imaging, and tumor biopsy yields a reasonable model for managing children with focal brainstem tumors.

show abstract

Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Klimo

Panandiker²,

Thompson

et al. 2013

PED

View full text Add to dashboard Cite

show abstract

“…These results are consistent with other studies that have patients with these diffuse intrinsic brainstem gliomas experiencing poor prognosis and survival outcomes of < 10% at 2 years in some cases [29]. Pilocytic astrocytomas tend to have much better outcomes with lower recurrence rates and a less aggressive invasion of the surrounding parenchyma [15]. …”

Section: Discussionsupporting

confidence: 82%

“…It is possible that more aggressive surgical measures were necessary given the malignant nature of these tumors possibly explaining our nonsignificant finding with regards to tumor extension versus focal location. Radical excision of the neoplasm is often the preferred method of surgery in most cases as partial resection is associated with relatively high recurrence rates (up to 20% in some cases) [15]. In cases where surgery is not performed, it is often at the discretion of the performing surgeon who anticipates possible severe complications or dangerous surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Brainstem Gliomas: A Retrospective Study of 180 Patients from the SEER Database

et al. 2019

View full text Add to dashboard Cite

Background/Aims: Large population-based studies are needed to assess the epidemiology and survival risk factors associated with pediatric brainstem gliomas. This retrospective study explores factors that may influence survival in this population. Methods: Utilizing the SEER database, the authors retrospectively assessed survival in histologically confirmed brainstem gliomas in patients aged 17 and younger. Survival was described with Kaplan-Meyer curves and multivariate regression analysis. Results: This analysis of 180 cases showed that age (hazard ratio [HR] 1.04, 95% CI 0.96–1.14, p = 0.34), non-white race (HR 1.00, 95% CI 0.35–2.85 p > 0.99), distant or invasive extension of the tumor (HR 0.4, 95% CI 0.08–2.53, p = 0.37), and radiation therapy (HR 1.27, 95% CI 0.52–3.11, p = 0.61) were not associated with decreased survival. High-grade tumor status (HR 8.64, 95% CI 3.49–21.41, p < 0.001) was associated with decreased survival. Partial resection (HR 0.11, 95% CI 0.04–0.30, p < 0.001) and gross-total resection (HR 0.03, 95% CI 0.01–0.14, p < 0.001) were associated with improved survival. Conclusions: High-grade brainstem gliomas have a worse prognosis. Early diagnosis and surgery appear to be associated with improved survival, while the role of radiation is unclear.

show abstract

“…[2526] Damage to the lower cranial nerves leads to dysphagia, absent gag and cough reflexes. [272829] These individuals are at risk for frequent micro aspirations and hence when indicated tracheostomy with PEG/Ryles tube feeding is recommended. Post-operative respiratory compromise is a serious issue and was observed in twelve of our patients.…”

Section: Discussionmentioning

confidence: 99%

Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

et al. 2014

View full text Add to dashboard Cite

Background:Cervicomedullary junction (CMJ) intramedullary tumors comprise of tumors that often pose a surgical challenge even in the present era. Though classified under brainstem glioma CMJ tumors are well amenable for surgical resection and have a good outcome. Various factors are involved in the outcome of these patients following surgery and a proper pre-operative assessment is often required to reduce the morbidity and mortality.Materials and Methods:Patients admitted in the Department of Neurosurgery with a diagnosis of CMJ intramedullary tumors from January 2001 to January 2010 were included in the study. Patients were analyzed retrospectively regarding their symptomatology, clinical findings, radiology and outcome after surgery. All patients underwent pre-operative magnetic resonance imaging (MRI) and post-operatively all were managed in the neurosurgery intensive care unit for days to weeks or as dictated by the clinical condition of the patient.Results:A total of 32 patients were included in the present study. The number of males was 21 (65.6%) and females were 11 (34.4%) respectively. The mean age of presentation was 22.97 ± 9.8 years and the mean duration of pre-operative symptoms was 13.3 ± 12.9 months. The tumor had extension from the CMJ into the cervical region in 17 (53.1%) and into the medullary region in 14 (43.8%) patients. Tumor decompression was done in 9 (28.1%) patients and gross near total excision done in 23 (71.87%) patients.Conclusions:Cervicomedullary tumors are a subset of tumors quite distinct from the usual brainstem tumors. Patients having predominant cervical involvement present early and have less post-operative deficits. Those with predominantly more medullary involvement present late, hence have a much more morbid outcome. Though closely related to vital neural structures, surgery forms the mainstay of treatment. Adequate pre-operative planning and preparation of the patient along with intense post-operative monitoring and ventilatory assistance as and when required helps in a good surgical outcome.

show abstract

Surgical considerations for ′intrinsic′ brainstem gliomas: Proposal of a modification in classification

Abstract: The surgical management of intrinsic brainstem tumors presents a surgical challenge; radical excision yielded a good outcome in the majority of cases. The authors propose a classification system for 'intrinsic' brainstem tumors for defining surgical strategy.

Cited by 27 publications

References 27 publications

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience

Pediatric Brainstem Gliomas: A Retrospective Study of 180 Patients from the SEER Database

Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

Contact Info

Product

Resources

About