Brain-stem glioma growth patterns

1993 ◽  
Vol 78 (3) ◽  
pp. 408-412 ◽  
Author(s):  
Fred J. Epstein ◽  
Jean-Pierre Farmer
Keyword(s):  
Brain Stem ◽  
Growth Patterns ◽  
Brain Stem Glioma ◽  
Mr Images ◽  
Content Type ◽  
Fiber Tracts ◽  
Glioma Growth ◽  
Stem Lesions ◽  
The Brain ◽  
Brain Stem Gliomas

✓ During the last decade, several authors have reported that certain brain-stem gliomas may be associated with a better prognosis than others. In this paper, retrospective correlations between the pathological findings and the magnetic resonance (MR) imaging appearance of 88 brain-stem gliomas are established. The authors propose an anatomical hypothesis that helps identify glioma growth patterns in general and that clarifies why cervicomedullary, dorsally exophytic, and focal tumors have a more favorable prognosis. According to this hypothesis, growth of benign gliomas of the brain stem is guided by secondary structures such as the pia, fiber tracts, and the ependyma, which in turn leads to stereotypical growth patterns that are clearly identified on MR images. The authors believe that this hypothesis, in conjunction with clinical data, may help establish selection criteria for the surgical treatment of specific brain-stem lesions.

Treatment of Recurrent Brain Stem Gliomas and Other Central Nervous System Tumors with 5-Fluorouracil, CCNU, Hydroxyurea, and 6-Mercaptopurine

Neurosurgery ◽  
1988 ◽  
Vol 22 (4) ◽  
pp. 691-693 ◽  
Author(s):  
Luis A. Rodriguez ◽  
Michael Prados ◽  
Dorcas Fulton ◽  
Michael S. B. Edwards ◽  
Pamela Silver ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Brain Stem ◽  
Central Nervous System Tumors ◽  
Brain Stem Glioma ◽  
Spinal Cord Tumors ◽  
The Brain ◽  
Brain Stem Gliomas ◽  
Time To Tumor Progression

Abstract Twenty-one patients with recurrent malignant central nervous system gliomas were treated with a combination of 5-fluorouracil, CCNU, hydroxyurea, and 6-mercaptopurine. Thirteen patients had brain stem gliomas, 3 patients had spinal cord gliomas, 3 patients had thalamic gliomas, and 2 patients had cerebellar astrocytomas. All patients had received radiation therapy, and 4 brain stem patients had also been treated with chemotherapy. Sixteen patients (76%) responded to treatment with either stabilization of disease or improvement. Nine of the 13 patients with brain stem gliomas (71%) had response or stabilization of disease. The median time to tumor progression (TTP) for the brain stem patients who responded or had stabilization of disease was 25 weeks. The median survival from recurrence for the brain stem glioma patients was 27 weeks. Patients with cerebellar, thalamic, and spinal cord tumors did very well, with an 87% response or stabilization of disease and a median TTP of 122 weeks.

Intraoperative identification of motor areas of the rhomboid fossa using direct stimulation

1993 ◽  
Vol 79 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Christian Strauss ◽  
Johann Romstöck ◽  
Christopher Nimsky ◽  
Rudolf Fahlbusch
Keyword(s):  
Brain Stem ◽  
Fourth Ventricle ◽  
Complete Removal ◽  
Direct Stimulation ◽  
Content Type ◽  
Rhomboid Fossa ◽  
Stem Lesions ◽  
Mass Lesions ◽  
The Brain ◽  
Motor Areas

✓ Intraoperative electrical identification of motor areas within the floor of the fourth ventricle was successfully carried out in a series of 10 patients with intrinsic pontine lesions and lesions infiltrating the brain stem. Direct electrical stimulation was used to identify the facial colliculus and the hypoglossal triangle before the brain stem was entered. Multichannel electromyographic recordings documented selective stimulation effects. The surgical approach to the brain stem was varied according to the electrical localization of these structures. During removal of the lesion, functional integrity was monitored by intermittent stimulation. In lesions infiltrating the floor of the fourth ventricle, stimulation facilitated complete removal. Permanent postoperative morbidity of facial or hypoglossal nerve dysfunction was not observed. Mapping of the floor of the fourth ventricle identifies important surface structures and offers a safe corridor through intact nervous structures during surgery of brain-stem lesions. Reliable identification is particularly important in mass lesions with displacement of normal topographical anatomy.

Noninvasive localization of brain-stem lesions in the cat with multimodality evoked potentials

1981 ◽  
Vol 54 (6) ◽  
pp. 740-750 ◽  
Author(s):  
Richard P. Greenberg ◽  
Donald M. Stablein ◽  
Donald P. Becker
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Evoked Potential ◽  
Animal Experiments ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Multimodality Evoked Potentials ◽  
Stem Lesions ◽  
The Brain ◽  
Fine Print

✓ Multimodality evoked potential (MEP) data from over 300 comatose head-injured patients suggest that central nervous system dysfunction of the brain stem and/or hemispheres can be localized with this noninvasive neuroelectric technique. Based on this work, decerebrate motor posturing and prolonged coma are not associated with brain-stem dysfunction but rather with dysfunction of the hemispheres, while absent pupillary and oculocephalic responses are correlated with brain-stem dysfunction alone. However, the accuracy with which MEP data localized human brain-stem or hemispheric dysfunction could not be confirmed by pathological correlation because of low mortality and the small number of autopsies obtained in the patients who died. Therefore, this study was undertaken in an animal model of brain-stem lesion. Complete brain-stem transections were made at the cervicomedullary junction, the medulla just caudal to the eighth nerve, and at the intercollicular region. All cortical visual evoked potential (VEP) peaks were reduced in amplitude and delayed by each of the brain-stem transections, but none of the peaks was abolished. In spite of brain-stem transection, VEP's can be used to gain information about hemispheric function. Somatosensory (SEP) and auditory cortically generated evoked potentials (AEP) were abolished by these brain-stem transections, but early-latency brain-stem SEP and AEP data could accurately localize specific areas of brain-stem dysfunction caused by the lesions. Observations made on human MEP data seem to be confirmed by these animal experiments. Correlations between human and cat MEP data are discussed.

Benign Brain Stem Lesions in Pediatric Patients with Neurofibromatosis: Case Reports

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 959-964 ◽  
Author(s):  
Corey Raffel ◽  
Gordon J. McComb ◽  
Sara Bodner ◽  
Floyd E. Gilles
Keyword(s):  
Brain Stem ◽  
Pediatric Patients ◽  
Tumor Imaging ◽  
Case Reports ◽  
Low Grade ◽  
Brain Stem Glioma ◽  
Computed Tomographic ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
The Brain

Abstract The symptoms and clinical courses of 4 patients with neurofibromatosis and lesions of the brain stem identifiable on computed tomographic and/or magnetic resonance imaging scans are described. Two patients underwent biopsy and both had low-grade astrocytomas with no evidence of anaplasia. Both received radiation and chemotherapy. The other 2 patients have been monitored without biopsy or treatment. Three patients are alive and clinically stable, having been followed up for an average of 4 years; neuroimaging studies have shown no change in their tumors. The fourth patient died of a supratentorial primitive neuroectodermal tumor. Imaging studies had shown no change in his brain stem lesion, which at autopsy was found to be a focal collection of fibrillary astrocytes. These data suggest that some patients with brain stem lesions and neurofibromatosis may have a prognosis distinctly different from that of the typical patient with a brain stem glioma. We recommend caution against aggressive operative and adjuvant therapy for brain stem lesions in patients with neurofibromatosis, unless progression of the lesion is documented clinically and/or by imaging.

A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions

1993 ◽  
Vol 78 (6) ◽  
pp. 987-993 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi ◽  
Hirohiko Gibo ◽  
Takayuki Kuroyanagi
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Fourth Ventricle ◽  
Medial Lemniscus ◽  
Content Type ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
Hazardous Procedure ◽  
The Brain ◽  
Fine Print

✓ Direct surgery for intra-axial lesions of the brain stem is considered a hazardous procedure, and morbidity of varying degrees cannot be avoided even with partial removal or biopsy. The main causes of morbidity relate to direct damage during removal of the lesion, selection of an entry route into the brain stem, and the direction of brain stem retraction. The authors examined the possibility of making a medullary incision and retracting the brain stem, taking into account the symptomatology and surgical anatomy, and found two safe entry zones into the brain stem through a suboccipital approach via the floor of the fourth ventricle. These safe entry zones are areas where important neural structures are less prominent. One is the “suprafacial triangle,” which is bordered medially by the medial longitudinal fascicle, caudally by the facial nerve (which runs in the brainstem parenchyma), and laterally by the cerebellar peduncle. The second is the “infrafacial triangle,” which is bordered medially by the medial longitudinal fascicle, caudally by the striae medullares, and laterally by the facial nerve. In order to minimize the retraction-related damage to important brain-stem structures, the brain stem should be retracted either laterally or rostrally in the suprafacial triangle approach and only laterally in the infrafacial triangle approach. Three localized intra-axial brain-stem lesions were treated surgically via the safe entry zones using the suprafacial approach in two and the infrafacial approach in one. The cases are described and the approaches delineated. Both approaches are indicated for focal intra-axial lesions located unilaterally and dorsal to the medial lemniscus in the lower midbrain to the pons. Magnetic resonance imaging is useful in selecting these approaches, and intraoperative ultrasonography is helpful to confirm the exact location of a lesion before a medullary incision is made. These approaches can also be used as routes for aspiration of brain-stem hemorrhage as well as for tumor biopsy.

scholarly journals Brain Stem Glioma in Childhood: Acute Hemiplegic Onset

1981 ◽  
Vol 8 (3) ◽  
pp. 263-264 ◽  
Author(s):  
S.J. Rothman ◽  
C.W. Olanow
Keyword(s):  
Glioblastoma Multiforme ◽  
Brain Stem ◽  
Abrupt Onset ◽  
Unusual Presentation ◽  
Brain Stem Glioma ◽  
Surgical Biopsy ◽  
Initial Manifestation ◽  
The Brain ◽  
Brain Stem Gliomas ◽  
Pure Motor

SUMMARY:Two children, age seven and 16 years, are described with the abrupt onset of a pure motor hemiplegia as the initial manifestation of a brain stem neoplasm. Subsequent rapid neurological deterioration localized the lesion to the brain stem and glioblastoma multiforme was diagnosed by surgical biopsy. It is suggested that brain stem gliomas with this unusual presentation are likely to be highly malignant and prone to rapid bulbar deterioration.

Stereotaxic biopsy of intrinsic lesions of the brain stem

1986 ◽  
Vol 65 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Terry W. Hood ◽  
Stephen S. Gebarski ◽  
Paul E. McKeever ◽  
Joan L. Venes
Keyword(s):  
Brain Stem ◽  
Histological Diagnosis ◽  
High Yield ◽  
Content Type ◽  
Stereotaxic Biopsy ◽  
Brain Stem Lesions ◽  
Low Incidence ◽  
Stem Lesions ◽  
Permanent Neurological Deficit ◽  
The Brain

✓ Despite improved brain-stem imaging by magnetic resonance and high-resolution x-ray computerized tomography, definitive diagnosis and therapy of intrinsic lesions of the brain stem require histological verification. A stereotaxic approach to brain-stem lesions provides a high yield of positive histological diagnosis with a low incidence of morbidity. A series of 14 stereotaxic procedures performed on 12 patients with intrinsic lesions of the mesencephalon, pons, and medulla is reviewed. A detailed description of the transfrontal approach used by the authors is presented. Definitive pathological diagnosis was obtained in all patients. There was no operative mortality and only one case of permanent neurological deficit. The significance of accurate histological diagnosis in the therapy of brain-stem lesions is discussed.

Spettroscopia protonica RM di lesioni isolate del tronco encefalico

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 37-38
Author(s):  
M. Cosottini ◽  
M. Mascalchi ◽  
M.C. Bianchi ◽  
M. Mortilla ◽  
M. Tosetti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Stem ◽  
Healthy Subjects ◽  
Brain Stem Glioma ◽  
Single Voxel ◽  
Neoplastic Lesions ◽  
Multiple Sclerosis Plaque ◽  
Brain Stem Lesions ◽  
Stem Lesions ◽  
Brain Stem Gliomas

Seven patients with solitary brain stem lesions (3 brain stem gliomas, 2 capillary telangectasias, 1 neuro-Behçet, 1 acute multiple sclerosis plaque) and 15 healthy volunteers were examined with single voxel proton MR speotroscopy using short TE STEAM or long TE PRESS techniques. The pontine spectrum in the healthy subjects showed a higher choline/creatine ratio than that observed in the normal supratentorial compartment. The three patients with brain stem glioma invariably showed a moderate to severe decrease of the N-acetyl-aspartate/creatine ratio associated with presence of lactate in two patients. The reduction of the N-acetyl aspartate/creatine ratio in the patients with non-neoplastic lesions was mild or absent and it was never associated with the presence of lactate. Even if further investigations are required to confirm these preliminary findings, our study indicates that proton MR speotroscopy may be of assistance in the differential diagnosis of neoplastic and non-neoplastic solitary brain stem lesions.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

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