Paediatric brainstem gliomas: prognostic factors and management.
BACKGROUND
Although most types of tumours involving the brainstem can be surgically removed, patients with diffuse pontine brainstem glioma do not benefit from surgical intervention. The aim of the present study is to establish whether clinical symptoms, their duration prior to diagnosis, the presence of enhancement on MRI scans and the histology of the lesion in paediatric brainstem glioma can guide the surgeon in choosing appropriate management options.


METHODS
We retrospectively reviewed the charts and MRI scans of paediatric patients admitted to Turin's Ospedale Regina Margherita with a diagnosis of brainstem glioma.


RESULTS
Patients with a diffuse pontine tumour on MRI scan (group 1) had a mean duration of symptoms prior to diagnosis of 2.61 months, 77% had symptoms involving at least one cranial nerve at diagnosis, and no MRI scans showed enhancement with gadolinium. No patients underwent radical surgery and 84.6% died. For all other patients (group 2), the mean duration of symptoms at diagnosis was 10.58 months, cranial nerve involvement was present in only 28.5%, and the MRI scans showed enhancement in 78.6%. Radical surgery was the treatment of choice (100%). In this study, survival of patients with diffuse pontine brainstem glioma was 25% at 2 years and survival of patients with any other brainstem glioma was 90% at 2 years.
Mauffrey
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Department of Pediatric Neurosurgery, Ospedale Regina Margherita, Torino, Italy. cmauffrey@yahoo.com