title: Exophytic glioma of the medulla: presentation, management and outcome.
abstract: OBJECTIVE
  Exophytic gliomas of the medulla are rare childhood tumors that mostly are pilocytic astrocytomas. Here we report our experience in 11 -children with this rare tumor.
  
  
  METHODS
  A retrospective study was performed using the records of children with exophytic gliomas of the medulla at Children's Hospital Medical Center in Tehran, Iran, from 2002 through 2013. The general, clinical, and radiological data and follow-up of all patients were reviewed.
  
  
  RESULTS
  The patients mostly were male aged from 11 months to 7 years. Swallowing problems, failure to thrive and nausea and vomiting were the most common symptoms. The time span between the onset of symptoms and the diagnosis was 2-24 months. Gross total resection of tumor was possible in 8 patients. Most tumors were pilocytic astrocytomas. Patients were followed for 2 months to 11 years (mean = 3.6 years). There was no intraoperative mortality. Recurrence occurred in 1 child with fibrillary astrocytoma.
  
  
  CONCLUSIONS
  Gross total resection of symptomatic dorsal exophytic medullary glioma is recommended. Most tumors are pilocytic astrocytomas. The attachment of these tumors to important brainstem structures usually inhibits total resection. Electrophysiological monitoring of sensorimotor pathways and cranial nerves can be helpful to preserve surrounding neural tissue during tumor resection and to minimize complications. Regular follow-up of patients with clinical examination and brain MRI is mandatory. Repeated surgery, radiation therapy and chemotherapy are suggested in cases with tumor recurrence or progression.
authors.affiliation: Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ghodsi
authors.forename: Abolghasem
authors.initials: A
authors.lastname: Mortazavi
authors.forename: Shima
authors.initials: S
authors.lastname: Shahjouei
authors.forename: Sara
authors.initials: S
authors.lastname: Hanaei
authors.forename: Arash
authors.initials: A
authors.lastname: Esmaeili
authors.forename: Farideh
authors.initials: F
authors.lastname: Nejat
authors.forename: Mostaf
authors.initials: M
authors.lastname: El Khashab
mesh_terms: D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local; D011859:Radiography; D016896:Treatment Outcome