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Journal of Neurosurgery Mar 1993During the last decade, several authors have reported that certain brain-stem gliomas may be associated with a better prognosis than others. In this paper, retrospective...
During the last decade, several authors have reported that certain brain-stem gliomas may be associated with a better prognosis than others. In this paper, retrospective correlations between the pathological findings and the magnetic resonance (MR) imaging appearance of 88 brain-stem gliomas are established. The authors propose an anatomical hypothesis that helps identify glioma growth patterns in general and that clarifies why cervicomedullary, dorsally exophytic, and focal tumors have a more favorable prognosis. According to this hypothesis, growth of benign gliomas of the brain stem is guided by secondary structures such as the pia, fiber tracts, and the ependyma, which in turn leads to stereotypical growth patterns that are clearly identified on MR images. The authors believe that this hypothesis, in conjunction with clinical data, may help establish selection criteria for the surgical treatment of specific brain-stem lesions.
Topics: Brain Neoplasms; Brain Stem; Glioma; Humans; Magnetic Resonance Imaging; Medulla Oblongata; Radiography; Spinal Cord Neoplasms
PubMed: 8433142
DOI: 10.3171/jns.1993.78.3.0408 -
Neurosurgery Feb 1997To evaluate the ability of magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) to distinguish neurofibromatosis Type 1 (NF-1) with brain... (Review)
Review
OBJECTIVE
To evaluate the ability of magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) to distinguish neurofibromatosis Type 1 (NF-1) with brain stem enlargement from diffuse pontine glioma (PG) in pediatric patients.
METHODS
A chart review was used to identify all patients with NF-1 and diffuse brain stem enlargement who were seen at our institution and who had undergone MRI. Comparison groups were as follows: 1) eight patients who did not have NF-1 but who did have diffuse PG, and 2) seven healthy children. Midsagittal diameters of the pons, midbrain, and medulla were measured in all patients, and the results were statistically analyzed. Two MRS variables were also statistically compared: N-acetyl aspartate and the vector sum of the metabolites choline and creatine/phosphocreatine.
RESULTS
In MRI-based measurements, only the pontine midsagittal diameter differed significantly between the NF-1 and PG groups (P = 0.002). Altogether, 21 children underwent MRS, including 6 in the NF-1 group. Measures of both MRS variables were significantly lower in patients with PG than in the others (P < or = 0.007). The two MRS variables classified the 21 children into the three respective groups with 100% accuracy. Of the seven patients with NF-1, four presented with symptoms attributable to brain stem involvement. The brain stems of all seven patients with NF-1 were hyperintense on T2-weighted magnetic resonance images, and five were isointense on T1-weighted images; only one exophytic tumor was identified. Four of the patients with NF-1 were followed up clinically without treatment; all remained alive and neurologically stable for a median of 40 months. All eight patients in the PG group were symptomatic at presentation, and all except one died despite therapy.
CONCLUSION
Both MRI measurements and MRS seem to be useful for distinguishing patients with NF-1 and diffuse brain stem enlargement from patients without NF-1 but with diffuse PG. They should be most helpful in differentiating symptomatic patients with NF-1 from patients with PG, thereby minimizing aggressive treatment and its side effects in patients destined to have better outcomes.
Topics: Adolescent; Aspartic Acid; Brain Neoplasms; Brain Stem; Child; Child, Preschool; Choline; Creatine; Diagnosis, Differential; Female; Glioma; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Mesencephalon; Neurofibromatosis 1; Phosphocreatine; Pons
PubMed: 9007866
DOI: 10.1097/00006123-199702000-00018 -
Archives of Disease in Childhood Jun 1999
Review
Topics: Brain Neoplasms; Brain Stem; Child; Family; Glioma; Humans; Palliative Care
PubMed: 10332008
DOI: 10.1136/adc.80.6.558 -
Der Radiologe Nov 1998Brain-stem gliomas occur mainly in childhood and are localized in the mesencephalon, pons and medulla oblongata. Diagnosis is a domain of MRI, requiring T2, T1 and KM....
Brain-stem gliomas occur mainly in childhood and are localized in the mesencephalon, pons and medulla oblongata. Diagnosis is a domain of MRI, requiring T2, T1 and KM. CT shows hemorrhage and calcification well. The criteria are the primary site, size, tumor growth, brain-stem enlargement, delineation, intralesional structure, exophytic components and enhancement. Secondary criteria are herniation, hydrocephalus and liquorgenic seeding. In CT glioma are hypodense, in MRI hyperintense in T2 and hypointense in T1. Enhancement is seen in 25-60% and does not allow differentiation of tumor vs nontumor or gradings. Factors influencing poor outcome are high grade, a short history, cranial nerve involvement, severe brain-stem enlargement, pontine site, diffuse growth and recurrency. The 5-year-survival rate is 30% (after radiation: focal tumors 85%, diffuse 20%). Most frequent are symptoms of brain pressure, cerebellum, cranial nerves and pyramidal tract. There is no agreement on whether biopsy is necessary or not. A diagnosis of tumor is highly suggestive if classical MRI findings fit the clinical history.
Topics: Adolescent; Brain Neoplasms; Brain Stem; Child; Child, Preschool; Female; Glioma; Humans; Magnetic Resonance Imaging; Male; Stereotaxic Techniques; Tomography, X-Ray Computed
PubMed: 9861650
DOI: 10.1007/s001170050441 -
Seminars in Ultrasound, CT, and MR Jun 2010Diffuse brainstem lesions are poorly defined, often large abnormalities and include tumors (gliomas and lymphomas) vasculitis (Behçet's disease), traumatic brainstem... (Review)
Review
Diffuse brainstem lesions are poorly defined, often large abnormalities and include tumors (gliomas and lymphomas) vasculitis (Behçet's disease), traumatic brainstem injury, degenerative disorders (Wallerian degeneration), infections, processes secondary to systemic conditions (central pontine myelinolysis, hypertensive or hepatic encephalopathy), and ischemic pathology (leukoaraiosis). Magnetic resonance imaging is the most appropriate imaging modality to use in evaluating lesions of this type, but often findings are nonspecific. Therefore, radiologists need to bear in mind such additional information as patient age and clinical features in making a differential diagnosis.
Topics: Brain Diseases; Brain Stem; Brain Stem Neoplasms; Diagnosis, Differential; Glioma; Hepatic Encephalopathy; Humans; Leukoaraiosis; Lymphoma; Magnetic Resonance Imaging; Myelinolysis, Central Pontine; Vasculitis, Central Nervous System; Wallerian Degeneration
PubMed: 20483393
DOI: 10.1053/j.sult.2010.03.002 -
Neurosurgery Sep 1990We present a 24-year-old patient with multiple chondromas of both hands, the pelvis, the left leg, and an associated brain stem glioma. There was no evidence of... (Review)
Review
We present a 24-year-old patient with multiple chondromas of both hands, the pelvis, the left leg, and an associated brain stem glioma. There was no evidence of hemangioma or dyschromia, and the condition was diagnosed as Ollier's disease, a special type of dyschondroplasia like Maffucci's syndrome and Kast's disease. An increased overall risk for development of malignant skeletal and nonskeletal tumors is associated with Maffucci's syndrome. The risk of malignant degeneration is lower in Ollier's disease. A glioma in the pons and the right lobe of the cerebellum was found in this patient. The literature describes an association with gliomas in only 12 cases of dyschondroplasia and an infratentorial localization in just one case. Signs of malignancy were histologically confirmed in 7 cases without significant preponderance of any one type. Our patient had a low-grade brain stem astrocytoma with fibrillar and gemistocytic components. A stereotactic serial biopsy made it possible to rule out malignant degeneration. Stereotactic brain tumor biopsy as a routine neurosurgical procedure is particularly valuable for deep space-occupying processes and forms the basis for therapy. In the present case, irradiation was not recommended.
Topics: Adult; Astrocytoma; Brain Neoplasms; Cerebellar Neoplasms; Enchondromatosis; Humans; Male; Pons
PubMed: 2234348
DOI: 10.1097/00006123-199009000-00029 -
Journal of Neurology, Neurosurgery, and... Oct 1972Thirteen cases of malignant glial tumours of the brain-stem that came to necropsy have been analysed in detail. These patients followed a rather uniform course defined...
Thirteen cases of malignant glial tumours of the brain-stem that came to necropsy have been analysed in detail. These patients followed a rather uniform course defined by the early onset of signs and symptoms of increased intracranial pressure, poor response to radiotherapy, and short total duration of illness. Pathological features were also similar in all cases, with each tumour showing areas ranging from benign to frankly malignant. This regional variability points to the limited usefulness of small biopsies and also indicates the need for complete necropsy studies. The term `spongioblastoma polare' should probably be avoided, and it is suggested that the histological classification of glial brain-stem tumours be similar to the classification of such tumours elsewhere in the neuraxis.
Topics: Adult; Age Factors; Astrocytoma; Brain Neoplasms; Brain Stem; Child; Child, Preschool; Cranial Nerves; Glioblastoma; Glioma; Humans; Infant; Intracranial Pressure; Middle Aged
PubMed: 4343481
DOI: 10.1136/jnnp.35.5.732 -
Archives of Neurology Feb 1968
Topics: Brain Neoplasms; Brain Stem; Glioma; Humans; Infant, Newborn; Male; Medulla Oblongata; Pons
PubMed: 5636073
DOI: 10.1001/archneur.1968.00470320098010 -
International Journal of Radiation... Jan 1998Tumors arising in the brain stem, comprising the midbrain, pons, and medulla oblongata, are now recognized as distinct clinico-pathological entities. Advances in... (Review)
Review
Tumors arising in the brain stem, comprising the midbrain, pons, and medulla oblongata, are now recognized as distinct clinico-pathological entities. Advances in neurosurgical techniques have made surgery not only feasible but the treatment of choice for some of these tumor types. Previously the mainstay of treatment, radiotherapy is now used more selectively. This article reviews the current state of knowledge with regard to tumors arising in the brain stem, the therapeutic options available for each, and provides recommendations with regard to management.
Topics: Brain Neoplasms; Brain Stem; Child; Glioma; Humans; Magnetic Resonance Imaging; Pons
PubMed: 9457808
DOI: 10.1016/s0360-3016(97)00572-5 -
Cancer Jun 1980Sixty-two pediatric patients with brain stem glioma diagnosed between 1964 and 1978 have been reviewed. Posterior fossa eploration was performed on 53% of the patients....
Sixty-two pediatric patients with brain stem glioma diagnosed between 1964 and 1978 have been reviewed. Posterior fossa eploration was performed on 53% of the patients. Pathology was obtained by biopsy in 58% of those explored. Fifty-four patients had definitive radiation therapy with a median dose of 5000 rads. The actuarial five-year survival for the entire group is 30%. A pathologic diagnosis was available from necropsy or biopsy on 36 of the 62 patients. One-half had malignant tumors, and none survived more than 16 months. The remaining patients with well-differentiated gliomas had five-year actuarial survival of 55%. The use of computed tomography (CT) has been found to be valuable in diagnosis and follow-up, as well as in the design of radiation therapy portals. The data demonstrate no dose response curve. We recommend local radiation therapy of 5000 to 5500 rads to the tumor area as defined by CT.
Topics: Actuarial Analysis; Adolescent; Brain Neoplasms; Brain Stem; Child; Child, Preschool; Female; Glioma; Humans; Male; Prognosis; Tomography, X-Ray Computed
PubMed: 7379009
DOI: 10.1002/1097-0142(19800601)45:11<2787::aid-cncr2820451113>3.0.co;2-v