Brainstem gliomas are heterogeneous Regardless of specific histology their location renders them inoperable Exophytic tumours are amenable for surgery Majority are malignant and prognosis is poor

1. Clinicopathological Study of
Brainstem Gliomas
Dr Amit Agrawal, MCh

2. ∗ Brainstem gliomas are heterogeneous
∗ Regardless of specific histology their location renders
them inoperable
∗ Exophytic tumours are amenable for surgery
∗ Majority are malignant and prognosis is poor
Introduction

3. ∗ Retrospective study
∗ April 1991-March 2001
∗ Total patients-104
Children -76
Adults -28

4. Age :
1st
decade : 47 2nd
decade : 29
Sex : Male : 60
Female : 44
Age & Sex Distribution

5. Symptoms
Symptoms Children Adults
Raised ICP
Cranial nerve
palsies
Limb weakness
Ataxia
Seizures
42
43
31
24
3
18
24
5
16
1

6. Signs
Signs No.
Papilloedema
Cranial nerve
palsies
Pyramidal signs
Cerebellar signs
Eye signs
55
56
40
35
30

7. Imaging (CT & MRI)
Region Diffuse Focal Exophytic
Midbrain
Pons
Medulla
Tectal
Cervico-
medullary
> 1 region
2
7
-
-
-
35
1
3
-
5
-
-
1
5
2
-
5
22

8. ∗ Symptomatic Hydrocephalus
-Ventriculoperitoneal shunt -43
-Endoscopy -5
∗ Diagnostic biopsy
-STB -15
-Endoscopic -4
∗ Definitive surgery -36
∗ Direct radiotherapy -49
Management

9. Endoscopic Procedures
Procedure No.
Endoscopic third
ventriculostomy
ETV+Endoscopic stenting
Endoscopic biopsy
4
1
4

10. Microsurgery
Procedure Cases
Midline suboccipital craniectomy
Pterional/subtemporal approach
Retromastoid suboccipital
craniectomy
Poppen’s approach
22
3
9
2

11. ∗ Malignant astrocytoma -25
∗ Pilocytic astrocytoma -15
∗ Fibrillary astrocytoma -5
∗ Inconclusive, Low grade glioma -3 each
∗ Mixed glioma, Glioblastoma, Ganglioglioma, SEGA
-1 each
Histopathology (n=55)

12. ∗ Respiratory distress –4
(1 expired)
∗ Post op CSF leak -1
∗ Pseudomeningocoele-1
Post op complications

13. ∗ 33 cases
∗ 1-84 months
∗ Mean-14 months
∗ Operated patients +radiotherapy -19
∗ Radiotherapy –
Following STB -5
Without biopsy -9
Follow up(n=33)

14. ∗ Duration -1-31 months
∗ Malignant astrocytoma( 6) 6 months
∗ Pilocytic astrocytoma ( 7) 12 months
∗ Fibrillary astrocytoma( 3) 11 months
∗ SEGA( 1) 6 months
∗ Low grade glioma( 1) 7 months
∗ Ganglioglioma( 1) 36 months
Microsurgery (n=19)

15. Microsurgery (n=19)
Histology Improved Status quo Worsened
Malig. Astro. (6)
Pilocy. Astro. (7)
Fib. Astro. (3)
SEGA (1)
Low gr. glioma (1)
Ganglioglioma (1)
-
-
-
-
-
-
2
3
2
1
1
1
4
4
1
-
-
-

16. Radiotherapy (14)
∗ Following STB (5)
malignant astrocytoma(4) - 6 months
low grade glioma(1) -7 months
∗ Without biopsy-9
duration 1-84 months
mean-9.9 months
Follow up (n=33)

17. Radiotherapy (n=14)
( STB & Direct RT )
Improved Status quo Worsened
STB
Malig. Astro (4)
Low gr. Glioma (1)
Direct RT (9)
-
-
3
1
5
1
-
4

27. ∗ Benign tumors better prognosis
∗ Exophytic lesions are amenable for surgery
∗ Diffuse,non-enhancing lesions in children direct
radiotherapy
∗ Endoscopy technique useful adjunct
Conclusion

28. Thank you