title: Patterns of neuroaxis dissemination of gliomas: suggestion of a classification based on magnetic resonance imaging findings.
abstract: BACKGROUND
  Local invasion is the hallmark of malignant glioma dissemination. Leptomeningeal dissemination, a serious complication of malignant gliomas, has been increasingly observed. To correlate the physiopathologic mechanisms and the magnetic resonance imaging patterns of neuroaxis dissemination, a classification of malignant glioma dissemination is proposed (Instituto de Neurologia de Curitiba Classification).
  
  
  METHODS
  This classification includes the following patterns of dissemination: leptomeningeal (type I), nodular (type Ia), diffuse (type Ib); subependymal (type II); satellite (type IIIa, IIIb); and mixed (type IV), combination of 2 or more previous types. Of 138 patients with histologically confirmed gliomas treated between 2000 and 2004, 10 presented neuroaxis dissemination and were evaluated.
  
  
  RESULTS
  The distribution of dissemination patterns was as follows: subependymal, 4 of 10; diffuse leptomeningeal, 1 of 10; nodular leptomeningeal, 1 of 10; and satellite, 4 of 10. Mean interval between primary tumor and dissemination was 4 months. The most frequent glioma dissemination risk factor was entering the ventricular system during surgery.
  
  
  CONCLUSIONS
  Improvements in our diagnostic imaging capabilities have contributed to a better understanding of the patterns of malignant glioma dissemination. Using this information, we present a useful classification scheme, applicable to patients with neuroaxis dissemination, which will help standardize future discussions aimed at understanding these patterns of tumor spread.
authors.affiliation: Neurosurgery Department, Instituto de Neurologia de Curitiba, PR, Brazil. inc@inc-neuro.com.br
authors.forename: Kelly Cristina
authors.initials: KC
authors.lastname: Bordignon
authors.forename: Mauricio Coelho
authors.initials: MC
authors.lastname: Neto
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ramina
authors.forename: Murilo Sousa
authors.initials: MS
authors.lastname: de Meneses
authors.forename: Ana Denise
authors.initials: AD
authors.lastname: Zazula
authors.forename: Luiz Gustavo Morato Pinto
authors.initials: LG
authors.lastname: de Almeida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005910:Glioma / Q000145:classification* / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000556:secondary; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis