PEDIATRIC BRAIN-STEM GLIOMAS - AN UPDATE

It has become evident that pediatric brain stem gliomas are a heteroge neous pathology and should be classified according to clinical and rad iological criteria. This classification has contributed to better trea tment and greatly improved prognosis. Based on a review of the literat ure, we, describe the different types of brain stem astrocytomas:repor ted, which are: cervicomedullary, exophytic, cystic, focal and diffuse . Particular attention is paid to therapeutic modalities. For the firs t three lesions named the treatment is surgical and oncological therap y should be evaluated only for regrowth of the mass. Focal tumors of s ro the medulla and pens are still treated empirically (surgically and/ or with radiotherapy), because a definitive therapeutic protocol has n ot yet been elaborated; on the other hand it is well estabilished that if the focal mass is in the midbrain this should merely be monitored by means of serial MRI, while radiotherapy should be applied in the ev ent of the tumor's growth. Diffuse gliomas are treated with oncologica l therapy, and surgery (for biopsy or tumor excision) is not indicated . Five illustrative cases from our department are presented.