BACKGROUND Brain stem tumors in adults are infrequent. Most reports of
surgical treatment for these tumors involve partial tumor removal in
highly selected patients. A more aggressive approach for removing tumo
rs, especially solid and intrinsic ones, has been controversial. METHO
DS Twenty-two adult patients with brain stem tumors were surgically tr
eated. Surgical techniques, potential risks, and selection of appropri
ate treatment were evaluated. RESULTS Tumors were totally or subtotall
y removed in 20 patients and only partially removed in two patients. S
erious complications such as respiratory disturbances and circulatory
dysfunction occurred in 10 patients. Eight patients with these complic
ations recovered after appropriate treatments. Upon discharge, most si
gns and symptoms improved in 17 patients. CONCLUSION Most brain stem t
umors, except for malignant gliomas and small ventral tumors, are amen
able to an aggressive surgical approach. Exophytic medullary tumors th
at present dorsally comprise the most benign subgroup of brain stem tu
mors. Total removal can enhance survival, improve the patient's qualit
y of life, and offer a favorable long-term prognosis. Appropriate mana
gement of postoperative complications is essential for good results. (
C) 1997 by Elsevier Science Inc.