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  • Surgical management of pediatric brain stem glioma: a series of 21 cases

    Final Number:

    Ahmed Farhoud MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Intra-axial brain stem tumors belong to the most challenging neurosurgical problems. For many years, the brain stem remained a no-man's land, but this concept changed recently due to recent advances in the diagnostic and surgical tools.

    Methods: we reviewed the surgical outcome of 21 pediatric cases surgically treated for brain stem glioma at the Neurosurgery Department, Alexandria University between 2008 and 2013. The series includes 10 boys and 11 girls. Age ranged from 2-18 years (mean 9 years), and follow up period ranged from 6 to 63 months

    Results: Among 29 surgical procedures, 9 procedures were carried out at the midbrain, 13 at the pons, and 5 at the medulla oblongata. The remaining 2 surgical interventions were for CSF diversion (V-P shunt in one case and 3rd ventriculostomy in the other). Eight patients were operated twice; 4 for tumor regrowth after initial partial excision, 2 as a planned second stage surgery for complex tumors demanding different approaches, and 2 for CSF diversion. Intra-operative neurophysiological monitoring was available only in 19 procedures, and all cases were operated without neuronavigation or intra-operative MRI. Total resection was achieved in 8 out of 27 procedures for tumor resection (29.6%), and the most common pathology encountered was pilocytic astrocytoma (14 cases). There was no post-operative mortality in this series, worsening of the pre-operative neurological status occurred in 12 patients but was permanent in only 2 cases. Six cases died during the follow up period; 3 cases had anaplastic astrocytoma (WHO G 3) and 3 other children suffered from diffuse pontine glioma (fibrillary astrocytoma WHO G2).

    Conclusions: Satisfactory surgical outcome is possible for brain stem gliomas with proper surgical indication and special surgical tactics. Microsurgery could be considered an additional treatment option for these cases.

    Patient Care: it proves that microsurgery could be considered an important treatment option for pediatric brain stem tumors in 3rd world countries in order to save children with low grade gliomas from the long-term complications of radiotherapy if possible

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) identify the indications of surgery in pediatric brain stem tumors. 2) know the surgical requirements for this type of surgery 3) identify factors affecting the outcome in pediatric brain stem tumors 4) describe the importance of interdisciplinary management in brain stem glioma.


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