title: Application of technical strategies for surgical management of adult intrinsic pontine gliomas: a retrospective series.
abstract: OBJECTIVE
  The authors retrospectively analyzed the surgical treatment of adult intrinsic pontine gliomas in their department, and to enhance the understanding of technical strategies to treat this disease.
  
  
  METHODS
  7 patients with intrinsic pontine gliomas were recruited for this study, between January 2011 and June 2013. All patients underwent preoperative MRI and Diffusion Tensor Imaging Fiber Tracking (DTI-FT). In addition, multimodal Intraoperative Neuromonitoring (IOM) and Intraoperative Neuronavigation were also applied during microsurgery.
  
  
  RESULTS
  7 patients with intrinsic pontine gliomas were treated at the West China Hospital of Sichuan University. Mean age, mean duration of symptoms prior to diagnosis, and mean duration of follow-up average time were 38.0 years, 2.0 months, and 23.4 months, respectively. The main presentations were progressive cranial nerve deficits and long tract signs. Total resection was achieved in 3 patients, subtotal resection in 2, and partial resection in 2. Postoperative pathological examination revealed: astrocytoma (WHO II) in 4 cases, anaplastic oligoastrocytoma (AO, WHO III) in one case, and anaplastic astrocytoma (AA, WHO III) in two cases. Postoperative radiotherapy were administered to all patients, and 4 patients with astrocytoma (WHO II) rejected chemotherapy. After 11-39 months of follow-up, patient symptoms were resolved or stable without aggravation except one patient died because of rapidly progressive glioma at 11 months after operation. MRI in other patients showed residual tumor size to be unchanged or without obviously recurrence.
  
  
  CONCLUSIONS
  Combining preoperative MRI with preoperative DTI-FT, surgery can be better assessed and the operation for adult intrinsic pontine gliomas can be maximally and safely resected with the aid of Multimodal IOMs and Intraoperative Navigation during microsurgery.
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University 37 Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University 37 Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China.
authors.forename: Yan-Ming
authors.initials: YM
authors.lastname: Ren
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University 37 Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China.
authors.forename: Xu-Hui
authors.initials: XH
authors.lastname: Hui
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University 37 Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China.
authors.forename: Xue-Song
authors.initials: XS
authors.lastname: Liu
authors.affiliation: Department of Radiology, West China Hospital of Sichuan University 37 Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University 37 Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China.
authors.forename: Yue-Kang
authors.initials: YK
authors.lastname: Zhang
keywords: Adult intrinsic pontine gliomas; diffusion tensor imaging fiber tracking (DTI-FT); intraoperative neuronavigation; multimodal intraoperative neuromonitoring (IOM)