The historical change of brainstem glioma diagnosis and treatment: from imaging to molecular pathology and then molecular imaging

Abstract

Understanding a process from shallow to deep is necessary for controlling and even curing diseases. The history of diagnosis and treatment of brainstem gliomas vividly reflects this process. The development of neuroimaging plays a great role in tumor treatment at different periods, including the period when brainstem gliomas were regarded as an homogenous incurable disease, and currently it is considered as an entity with high heterogeneity. Presently, it is not enough to just rely on the conventional neuroimaging techniques to determine the anatomic location of a tumor and its relationship with normal tissues. The development of molecular genetics and molecular imaging further promotes the progress of individualized and precision diagnosis and treatment in brainstem gliomas. In this paper, we summarize the evolution of brainstem glioma radiological classification mainly focusing on the aspects of imaging and surgical treatment. In the meanwhile, we reviewed the recent progresses in the fields of molecular genetics and molecular imaging.

Cutting Edge Therapeutic Insights Derived from Molecular Biology of Pediatric High-Grade Glioma and Diffuse Intrinsic Pontine Glioma (DIPG)

“…DIPG presents a special challenge as their diffuse nature in the brainstem makes surgery not feasible [31,32]. Recent studies have shown MRI-guided stereotactic biopsy to be a safe and reliable method of molecularly characterizing a DIPG patient [33,34], and others were able to detect mutational status using cerebrospinal fluid-sourced tumor DNA [35].…”

Posterior Fossa Tumors

“…[82][83][84][85] The development of molecular genetics and molecular imaging further promotes the progress of individualized diagnosis and therapy of BSG. 86 Prognosis and treatment depend upon the clinical symptoms and their duration as well as its location within the brainstem; the diffuse intrinsic type has the worst prognosis of all BSG, with median survival rarely exceeding 9 months. Focal midbrain tumors have a more indolent course with 80% of them showing 5 years free survival.…”