Clinical Analysis of Brain Stem Glioma

Kim, Dong Seok; Choi, Joong Uhn; Chung, Sang Sup; Lee, Kyu Chang

Abstract

The authors reviewed the cases of 25 patients, who were diagnosed as brain stem glioma by computerized tomography. The common presenting complains were the cranial nerve palsies, long tract signs and cerebellar dysfunction. Four distinct types of brain stem gliomas were identified based on CT scan characteristics: Type I included diffuse tumors; Type II included focal tumors; Type III included tumors involving cervicomedullary portion; Type IV(a) included exophytic tumors extending ventrally or laterally into the cerebellopontine or prepontine cistersns; Type IV(b) included exophytic tumors extending dorsally into fourth ventricle. The clinical presentation, efficacy of surgical intervention, pathology, and prognosis of those tumors were correlated within these typing. The prognosis was poorer in children who presented with multiple cranial nerve palsies, and such children were more likely to have malignant astrocytoma. Type I(diffuse tumors) had the poorest prognosis and less response to radiation while Type II(focal tumors) had relatively good response to radiation. Through surgery and post operative radiotherapy, survival times were significantly longer in patients with Type III(cervicomedullary tumor) which was more likely to be low grade astrocytoma. The prognosis of patients with Type IV-b(4th ventricle tumor) was variable but better than those with Type IV-a(prepontine tumors) or Type I(diffuse tumors). Patient with tumor biopsies that were histologically benign survived significantly longer than those whose tumors were malignant. It is concluded that patient with Type III cervicomedullary tumors or Type IV exophytic tumor may be improved through surgery and postoperative radiotherapy, and radiotherapy is useful method in treatment of patients with Type I diffuse tumors or Type II focal tumors.