Brainstem Glioma: Case Report [glioma De Tallo Cerebral: Reporte De Caso]

Brainstem gliomas have historically been one of the most difficult pediatric cancers to treat. Tumors arising in the brainstem were once uniformly discounted as surgically resectable lesions. Early neurosurgeons thought this location to be inoperable and fraught with disaster. The advent of computed tomography (CT), magnetic resonance imaging (MRI) and sophisticated neurophysiologic monitoring techniques have significantly advanced the surgical treatment of these lesions. Gliomas within the brainstem comprise 10-20% of all pediatric CNS tumors. Brainstem gliomas can occur at any age, although they generally present in childhood, with the mean age of diagnosis at 7 to 9 years. There is no gender predilection. Brainstem gliomas are now recognized as a heterogeneous group of tumors. The classification systems provide a framework to predict growth patterns, surgical resectability and overall prognosis for these heterogeneous tumors. These systems allow the surgeon to better differentiate low-grade tumors from the diffuse inoperable tumor type. We present a case as an example of the approach to these tumours.106479483Alvisi, C., Cerisoli, M., Maccheroni, M.E., Long-term results of surgically treated brainstem gliomas (1985) Acta Neurochir, 76, pp. 12-17Epstein, F., McCleary, E.L., Intrinsic brain-stem tumors of childhood: Surgical indications (1986) J Neurosurg, 64, pp. 11-15Berger, M.S., Edwards, M.S., Lamasters, D., Davis, R.L., Wilson, C.B., Pediatric brain stem tumors: Radiographic, pathological, and clinical correlations (1983) Neurosurgery, 12, pp. 298-302Dechambre, S., Duprez, T., Lecouvet, F., Raftopoulos, C., Gosnard, G., Diffusion-weighted MRI postoperative assessment of an epidermoid tumour in the cerebellopontine angle (1999) Neuroradiology, 41, pp. 829-831Albright, A.L., Packer, R.J., Zimmerman, R., Rorke, L.B., Boyett, J., Hammond, G.D., Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: A report from the Children's Cancer Group (1993) Neurosurgery, 33, pp. 1026-1030Weiner, H.L., Freed, D., Woo, H.H., Rezai, A.R., Kim, R., Epstein, F.J., Intraaxial tumors of the cervicomedullary junction: Surgical results and long-term outcome (1997) Pediatr Neurosurg, 27, pp. 12-18Deletis, V., Sala, F., Morota, N., Intraoperative neurophysiological monitoring and mapping during brain stem surgery: A modern approach (2000) Operative Techniques in Neurosurgery, 3, pp. 109-113Morota, N., Deletis, V., Epstein, F.J., Kofler, M., Abbott, R., Lee, M., Ruskin, K., Brain stem mapping: Neurophysiological localization of motor nuclei on the floor of the fourth ventricle (1995) Neurosurgery, 37, pp. 922-930Broniscer, A., Leite, C.C., Lanchote, V.L., Machado, T.M., Cristofani, L.M., Radiation therapy and high dose tamoxifen in the treatment of patients with diffuse brainstem gliomas: Results of a Brazilian cooperative study (2000) J Clin Oncol, 18, pp. 1246-1253. , Brainstem Glioma Cooperative GroupBowers, D.C., Krause, T.P., Aronson, L.J., Barzi, A., Burger, P.C., Carson, B.S., Second surgery for recurrent pilocytic astrocytoma in children (2001) Pediatr Neurosurg, 34, pp. 229-23