Introduction: Much of the nihilism associated with primary brainstem tumors in children has been reduced in the last decade through the promising results of a few pediatric series. The same cannot be said for the attitudes of adult neurosurgeons faced with a primary, intrinsic brainstem tumor. The literature is sparse and pessimism is prevalent. This large series of adult brainstem tumors underscores the importance of distinguishing focal from diffuse and the encouraging surgical results seen with an aggressive treatment algorithm.
Methods: A retrospective study was conducted of all adult patients who presented with an intrinsic brainstem tumor and who underwent surgery between January 2000 and December 2010. Patient records were used and data was updated after telephone interviews. Any patient who was subsequently proven to have an extra-axial tumor was excluded from this study.
Results: In the 10 year period 136 patients underwent surgery for a presumed intrinsic brainstem tumor. All patients younger than 18 years of age at time of presentation (n=104) were excluded and only one patient was found to have a secondary neoplasm. Of the 31 patients, 16 have died of their disease and 4 were significantly worse after surgery. The overall survival (OS) rate is 61% and progression free survival (PFS) is 45% at 5 years.
Conclusions: An aggressive surgical approach to patients with presumed intrinsic brainstem tumors significantly improves OS and PFS compared to adult non-surgical series. Although complications may be incapacitating, they are relatively uncommon and certainly acceptable.
Patient Care: Reducing the nihilism associated with intrinsic brainstem tumors and emphasizing the enormous importance of pre-operative diagnosis based on imaging
Learning Objectives: The importance of distinguishing focal from diffuse brainstem lesions.
The surgical approach to brainstem intra-axial tumors.
The survival advantage of an aggressive surgical treatment algorithm