Brainstem gliomas - A 10-year institutional review

Case records of 37 patients with a diagnosis of brainstem glioma treated at the Montreal Children's Hospital from June 1989 to June 1999 were reviewed . 15 patients had diffuse pontine gliomas and 22 patients had focal forms o f brainstem gliomas, The two groups were compared with respect to age, clin ical evolution, radiological appearance, type of surgery practised, histolo gical diagnosis, adjuvant treatments and survival. A non-pontine brainstem location, a cystic or exophytic component, bright enhancement with gadolini um injection, a histological diagnosis of pilocytic astrocytoma or gangliog lioma were favourable prognostic factors. Progression-free survival and ove rall survival were significantly worse in the group of patients with diffus e pontine gliomas. The relative impact of radical surgery and/or radiothera py is analysed. Surgery coupled to adjuncts such as navigation, ultrasound and monitoring plays an important role for focal brainstem lesions. Focal/c onformal radiotherapy has an adjuvant role but better treatments are needed for the diffuse pontine brainstem lesions.