Radical resection of focal brainstem gliomas: is it worth doing?
OBJECTIVE
Despite revolutionary technical advancement in neuroimaging and operative neurosurgery, surgical extirpation of focal brainstem glioma (BSG) remains steeped in controversy. In this study, we evaluated our senior author's (CT) surgical experience in radically treating these tumours in children to determine the safety and efficacy of such approach.


METHODS
Thirty-four consecutive patients aged between 3 and 16 years who underwent endoscope-assisted microsurgery for focal BSG with the intent of radial resection from 1999 to 2005 were evaluated. The clinical outcome at 6 months and long-term survival were analysed.


CONCLUSIONS
Thirty-one patients had >90% tumour resection and the remainder had >50%. There was no perioperative mortality. The average follow-up was 46 months. Twenty-three patients (74%) harboured low-grade gliomas, whilst the remainder (26%) had high-grade gliomas. Kaplan-Meier survival analysis revealed marked difference in the 5-year survival rates between the two groups (100% vs 33%). Multivariate analysis demonstrated that the degree of tumour resection was not associated with poor outcome at 6 months. This series underscores the benefits of surgical resection for focal BSG. Radical resection can be achieved in a majority of patients with favourable outcome regardless of tumour pathology.
Teo
Charles
C
Centre for Minimally Invasive Neurosurgery, Barker Street, Randwick, NSW, 2031, Australia.
Siu
Timothy L
TL
D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D044583:Neuroendoscopy; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016896:Treatment Outcome