Focal brain-stem astrocytomas causing symptoms of involvement of the facial nerve nucleus: long-term survival in six pediatric cases.
Six children with a history of isolated facial nerve dysfunction or dizziness and nausea were treated for brain-stem glioma between 1984 and 1992. Computerized tomography and/or magnetic resonance (MR) imaging showed a focal, uniformly enhancing mass involving the facial nerve nucleus of the pons. All patients underwent biopsy; the histological diagnosis was juvenile pilocytic astrocytoma in five cases. In the remaining case the biopsy was nondiagnostic, although the surgeon believed that the lesion was a glioma. Postoperatively, five patients underwent conventional focal megavoltage radiation therapy (180 to 200 cGy/day) over a period of 5 1/2 weeks to a total dose of approximately 5400 cGy. One child's family refused radiation therapy; she remained well and stable for 4 years, despite persistent facial weakness, and was eventually lost to follow-up review. Four irradiation-treated patients had complete resolution of their tumors on MR images and have had no evidence of neuropsychological or neuroendocrinological deficits during 4 1/2 to 8 years of follow-up evaluation. Patients whose neuroradiological studies show a lesion resembling those in this series should undergo biopsy and, if the histology of a low-grade tumor (in particular, a juvenile pilocytic astrocytoma) is confirmed, should then receive focal radiation therapy with conventional megavoltage dosages.
Edwards
M S
MS
Department of Neurological Surgery (Division of Pediatric Neurosurgery and Brain Tumor Research Center), School of Medicine, University of California, San Francisco.
Wara
W M
WM
Ciricillo
S F
SF
Barkovich
A J
AJ
D001254:Astrocytoma / Q000150:complications* / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy; D001706:Biopsy; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy; D001933:Brain Stem; D002648:Child; D002675:Child, Preschool; D005155:Facial Nerve Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome