The Surgical Resection of Brainstem Glioma: Outcomes and Prognostic Factors

Faulkner, Harrison; Arnaout, Omar; Hoshide, Reid; Young, Isabella M.; Yeung, Jacky T.; Sughrue, Michael E.; Teo, Charles

doi:10.1016/j.wneu.2020.10.147

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…Stereotactic biopsy is typically performed when the tumor is inoperable. However, even if the tumor is operable, the risk of persistent neurological deficits due to surgery is 20–30% [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions

Furtak¹,

Śledzińska

Bebyn

et al. 2021

Brain Sciences

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Stereotactic biopsy of posterior fossa lesions is often regarded as hazardous due to the critical structures in that area. Therefore, the aim of the study was to evaluate the diagnostic accuracy and safety of infratentorial stereotactic biopsy of brainstem or cerebellar lesions and its associations with other clinical, laboratory, and radiological parameters. From January 2000 to May 2021, 190 infratentorial stereotactic biopsies of posterior fossa tumors, including 108 biopsies of brainstem lesions, were performed. Moreover, 63 supratentorial biopsies of cerebral peduncle lesions were analyzed to compare the safety and efficacy of both approaches. Additionally, the presence of antibodies against Toxoplasma gondii and Epstein–Barr Virus (EBV) were documented in 67 and 66 patients, respectively, and magnetic resonance imaging (MRI) scans were evaluated in 114 patients. Only 4% of patients had minor complications and 1.5% had major complications, including one patient who died from intracranial bleeding. Nine (4.7%) biopsies were non-diagnostic. Isocitrate dehydrogenase 1 (IDH1) mutation, 1p/19q codeletion, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status were assessed in 29 patients, and were non-diagnostic in only 3 (10.3%) cases. Patients with high-grade gliomas (HGG) were more frequently seropositive for T. gondii than individuals with low-grade gliomas (LGG; p < 0.001). A total of 27% of HGG and 41% of LGG were non-enhancing on MRI. The infratentorial approach is generally safe and reliable for biopsy of brainstem and cerebellar lesions. In our study, the safety and efficacy of supratentorial biopsy of the cerebral peduncle and infratentorial biopsy of lesions below the cerebral peduncle were comparably high. Moreover, patients with HGG were more frequently seropositive for T. gondii than patients with LGG, and the relationship between toxoplasmosis and gliomagenesis requires further investigation.

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Section: Discussionmentioning

confidence: 99%

Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions

Furtak¹,

Śledzińska

Bebyn

et al. 2021

Brain Sciences

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“…Additionally, a histogram-based ADC-texture analysis of the solid tumor tissue was performed using the freely available software package FireVoxel (build 369, https://firevoxel.org/, 7 January 2022) [20]. 3D ROIs were placed as described above together with 3D ROIs of the basal ganglia, with values calculated by the FireVoxel software for ADC percentile values (ADC (10), ADC (25), ADC (75), ADC (90)) and the statistical measurements skewness and kurtosis, as well as entropy. ADC percentile values were referenced to the individual basal ganglia, resulting in relative ADC percentile data (rADC (xx)).…”

Section: Mr Imaging and Analysismentioning

confidence: 99%

“…Due to the localization of malignant diffuse gliomas of the midline, tumor resection is often not possible. Stereotactic biopsy, however, has become a standard procedure available in specialized centers [8][9][10][11]. In general, obtaining a biopsy is also recommended in children; however, this is still debated [9].…”

Section: Introductionmentioning

confidence: 99%

Differences in the MRI Signature and ADC Values of Diffuse Midline Gliomas with H3 K27M Mutation Compared to Midline Glioblastomas

Raab

Banan

Akbarian

et al. 2022

Cancers

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We conducted a two-center retrospective survey on standard MRI features including apparent diffusion coefficient mapping (ADC) of diffuse midline gliomas H3 K27M-mutant (DMG) compared to midline glioblastomas H3 K27M-wildtype (midGBM-H3wt). We identified 39 intracranial DMG and 18 midGBM-H3wt tumors. Samples were microscopically re-evaluated for microvascular proliferations and necrosis. Image analysis focused on location, peritumoral edema, degree of contrast enhancement and DWI features. Within DMG, MRI features between tumors with or without histomorphological GBM features were compared. DMG occurred in 15/39 samples from the thalamus (38%), in 23/39 samples from the brainstem (59%) and in 1/39 tumors involving primarily the cerebellum (2%). Edema was present in 3/39 DMG cases (8%) versus 78% in the control (midGBM-H3wt) group (p < 0.001). Contrast enhancement at the tumor rim was detected in 17/39 DMG (44%) versus 67% in control (p = 0.155), and necrosis in 24/39 (62%) versus 89% in control (p = 0.060). Strong contrast enhancement was observed in 15/39 DMG (38%) versus 56% in control (p = 0.262). Apparent diffusion coefficient (ADC) histogram analysis showed significantly higher skewness and kurtosis values in the DMG group compared to the controls (p = 0.0016/p = 0.002). Minimum relative ADC (rADC) values, as well as the 10th and 25th rADC-percentiles, were lower in DMGs with GBM features within the DMG group (p < 0.001/p = 0.012/p = 0.027). In conclusion, DMG cases exhibited markedly less edema than midGBM-H3wt, even if histomorphological malignancy was present. Histologically malignant DMGs and midGBM-H3wt more often displayed strong enhancement, as well as rim enhancement, than DMGs without histomorphological malignancy. DMGs showed higher skewness and kurtosis values on ADC-histogram analysis compared to midGBM-H3wt. Lower minimum rADC values in DMGs indicated malignant histomorphological features, likely representing a more complex tissue microstructure.

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“…PLGGs occur in 60%, either in the supra-or in the infratentorial compartment, while aLGGs occur in 60% of cases supratentorially, with 80% in eloquent regions [6,18]. In children, certain tumor locations, such as the tectum or the dorsal brainstem, are pathognomonic for pLGG, specifically pilocytic astrocytoma (PA), and it is disputed whether these tumors even require a biopsy to confirm the diagnosis, since surgery around the brainstem has a rate of postoperative morbidity of up to 30% [9,19]. Therefore, if hydrocephalus is apparent, endoscopic biopsy is obtained simultaneously to an endoscopic third ventriculostomy (ETV), which is indicated in order to treat the aqueduct stenosis caused by the tumor [20][21][22].…”

Section: Histology and Anatomical Locationmentioning

confidence: 99%

Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

2021

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Two thirds of pediatric gliomas are classified as low-grade (LGG), while in adults only around 20% of gliomas are low-grade. However, these tumors do not only differ in their incidence but also in their location, behavior and, subsequently, treatment. Pediatric LGG constitute 65% of pilocytic astrocytomas, while in adults the most commonly found histology is diffuse low-grade glioma (WHO II), which mostly occurs in eloquent regions of the brain, while its pediatric counterpart is frequently found in the infratentorial compartment. The different tumor locations require different skillsets from neurosurgeons. In adult LGG, a common practice is awake surgery, which is rarely performed on children. On the other hand, pediatric neurosurgeons are more commonly confronted with infratentorial tumors causing hydrocephalus, which more often require endoscopic or shunt procedures to restore the cerebrospinal fluid flow. In adult and pediatric LGG surgery, gross total excision is the primary treatment strategy. Only tumor recurrences or progression warrant adjuvant therapy with either chemo- or radiotherapy. In pediatric LGG, MEK inhibitors have shown promising initial results in treating recurrent LGG and several ongoing trials are investigating their role and safety. Moreover, predisposition syndromes, such as neurofibromatosis or tuberous sclerosis complex, can increase the risk of developing LGG in children, while in adults, usually no tumor growth in these syndromes is observed. In this review, we discuss and compare the differences between pediatric and adult LGG, emphasizing that pediatric LGG should not be approached and managed in the same way as adult LCG.

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The Surgical Resection of Brainstem Glioma: Outcomes and Prognostic Factors

Cited by 20 publications

References 34 publications

Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions

Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions

Differences in the MRI Signature and ADC Values of Diffuse Midline Gliomas with H3 K27M Mutation Compared to Midline Glioblastomas

Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

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