Brain Stem Gliomas natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural History

Radiotherapy-induced neoplasms tend to be more aggressive in their natural history than their de novo counterparts.

Complications

Morbidity is due to the location of the space-occupying lesion and compression of surrounding structures; because these structures regulate basic body functions of blood pressure, respiration, and swallowing as well as motor and sensory functions, compression can produce substantial neurological disability.

Sudden death can result from increased intracranial pressure and subsequent cerebral herniation. This may be a consequence either of edema induced by the tumor or of hemorrhage into the neoplasm.

Prognosis

The prognosis of brainstem gliomas depend on:

• The type of brain stem glioma
• Where the tumor is found in the brain and if it has spread within the brain stem
• Age of the child when diagnosed
• Whether or not the child has a condition called neurofibromatosis type 1
• Whether the tumor has been newly diagnosed or has recurred.

As a general rule, dorsal exophytic tumors and cervicomedullary tumors tend to have a good prognosis with treatment, and diffuse type has the worst prognosis with treatment. Adults tend to have a better prognosis than childhood brainstem gliomas.

• Diffuse brainstem glioma
  • Terrible prognosis
  • 90-100% patients die within 2 years of diagnosis
• Focal (tectal glioma)
  • Excellent long term survival with CSF shunting (essentially benign lesions)
• Focal (other)
  • Good long-term prognosis with surgery
• (Dorsally) exophytic tumors
  • Good long-term prognosis with surgery