History of Brainstem Glioma Surgery

ABSTRACTThe authors present a rare case of calcified (ossified) chronic epidural hematoma developed in a six-and-a-half-yearold female patient who was operated for cerebellar astrocytoma 6 months earlier. There was no history of trauma. Ossified epidural hematoma was seen as an incidental finding in the follow-up in computed tomography scan after 6 months of primary glioma surgery. Ossified chronic epidural hematoma with thick collagenous wall and newly formed bone on dura was excised. The development of calcified chronic subdural hematoma after decompressive intracranial surgery is a well-known occurrence, but the fact that a calcifi ed epidural hematoma, which is rare and which can also develop after decompressive surgery, and the occurrence of calcified (ossified) epidural hematoma after postfossa a glioma surgery is not yet reported. The second case is a 9-year-old male anemic child with a history of fall while playing 5 months earlier who presented with headache of 3 months duration. He had bifrontal calcifi ed epidural hematoma operated by craniotomy and excision of calcifi ed dural edge.

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Surgical considerations for maximal safe resection of exophytic brainstem glioma in the pediatric age group

Surgical Neurology International ◽

10.25259/sni_318_2021 ◽

2021 ◽

Vol 12 ◽

pp. 310

Author(s):

Ayman Tarek Mahmoud ◽

Abdelrhman Enayet ◽

Ahmed Mohamed Ahmed Alselisly

Keyword(s):

Surgical Techniques ◽

Pediatric Brain Tumors ◽

Brainstem Glioma ◽

Low Grade ◽

Total Excision ◽

Glioma Surgery ◽

Pediatric Age Group ◽

Radiological Data ◽

Tertiary Center

Background: Brainstem glioma is the leading cause of morbidity and mortality among all central nervous system tumors, especially in childhood as it represents about 20% of all pediatric brain tumors. Therefore, this study aimed to present our experience in a tertiary center in a developing country with limited resources for the surgical management of exophytic brainstem gliomas. Methods: This retrospective study included pediatric patients with brainstem (midbrain, pontine, or medullary) focal or diffuse gliomas whether low or high grade that had dorsal, ventral, or lateral exophytic component who were presented to our hospitals from January 2019 to January 2021. The patients’ data were collected, such as age, sex, preoperative and postoperative clinical condition, radiological data, surgical approach, extent of tumor removal, histopathology, follow-up period, and adjuvant therapy. Results: A total of 23 patients were included in this study. The telovelar approach was used in 17 patients, the supracerebellar infratentorial approach in three patients, and the retrosigmoid, transcerebellar, and occipital transtentorial approach once for each patient. Twenty patients underwent near-total excision, and three underwent subtotal excision. Two-thirds of our cases (17 patients) were low-grade gliomas, with the remaining one-third comprising entirely of either anaplastic astrocytoma (five patients) or glioblastoma multiforme (one patient). The follow-up period of the patients extended from 3 months to 24 months. Conclusion: Exophytic brainstem glioma surgery can result in good outcomes with minimal complications when near-total excision is attempted through a properly chosen approach and adherence to some surgical techniques and considerations.

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Insular glioma surgery: an evolution of thought and practice

Journal of Neurosurgery ◽

10.3171/2018.10.jns181519 ◽

2019 ◽

Vol 130 (1) ◽

pp. 9-16 ◽

Cited By ~ 8

Author(s):

Shawn L. Hervey-Jumper ◽

Mitchel S. Berger

Keyword(s):

Internal Capsule ◽

World Health ◽

Surgical Approaches ◽

High Grade ◽

Glioma Surgery ◽

Lenticulostriate Arteries ◽

History Of ◽

High Grade Gliomas ◽

Cortical Regions ◽

Health Organization

OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II–IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula’s proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.

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