Journal of Pediatric Neurology 2021; 19(04): 247-251
DOI: 10.1055/s-0040-1714068
Original Article

The Spectrum of Brain Stem Lesions in Children

Hanuman Prasad Prajapati
1   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
,
Raj Kumar
1   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
› Author Affiliations
Funding None.

Abstract

The objective of this study was to describe the clinicodemographic profiles, management, and outcomes of brain stem lesions in 53 pediatric patients with brain stem lesions. Most of the patients were male, 6 to 10 years of age (8.66 ± 4.69). Out of 53 patients, there were 77.36% brain stem gliomas, 11.32% tuberculomas, 5.66% abscesses, 3.77% cavernomas, and 1.89% schwannomas. With advancement in neuroimaging (e.g., tractography), intraoperative technology (e.g., ultrasound, neurophysiological monitoring, and magnetic resonance imaging), and safe and precise incision for particular lesions, majority of brain stem lesions had improved outcomes (67.92%) with significant reduction in morbidity and mortality (11.32%).



Publication History

Received: 17 April 2020

Accepted: 25 May 2020

Article published online:
10 August 2020

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  • References

  • 1 Pereira EA, Jegan T, Green AL, Aziz TZ. Awake stereotactic brainstem biopsy via a contralateral, transfrontal, transventricular approach. Br J Neurosurg 2008; 22 (04) 599-601
  • 2 Samadani U, Stein S, Moonis G, Sonnad SS, Bonura P, Judy KD. Stereotactic biopsy of brain stem masses: decision analysis and literature review. Surg Neurol 2006; 66 (05) 484-490 , discussion 491
  • 3 Fisher PG, Breiter SN, Carson BS. et al. A clinicopathological reappraisal of brain stem tumor classification. Cancer 2000; 89 (07) 1569-1576
  • 4 Epstein F, McCleary EL. Intrinsic brain-stem tumors of childhood: surgical indications. J Neurosurg 1986; 64 (01) 11-15
  • 5 Edgeworth J, Bullock P, Bailey A, Gallagher A, Crouchman M. Why are brain tumours still being missed?. Arch Dis Child 1996; 74 (02) 148-151
  • 6 Galbraith JG, Sahni P. Diagnosis of brainstem tumors. Hosp Med 1970; 6: 134-141
  • 7 Sarkari NBS, Bickerstaff ER. Relapses and remissions in brain stem tumours. BMJ 1969; 2 (5648): 21-23
  • 8 Choudhri AF, Whitehead MT, Klimo Jr P, Montgomery BK, Boop FA. Diffusion tensor imaging to guide surgical planning in intramedullary spinal cord tumors in children. Neuroradiology 2014; 56 (02) 169-174
  • 9 Galanis E, Buckner JC, Novotny P. et al. Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas. J Neurosurg 2000; 93 (02) 201-207
  • 10 Maria BL, Rehder K, Eskin TA. et al. Brainstem glioma: I. Pathology, clinical features, and therapy. J Child Neurol 1993; 8 (02) 112-128
  • 11 Selvapandian S, Rajshekhar V, Chandy MJ. Brainstem glioma: comparative study of clinico-radiological presentation, pathology and outcome in children and adults. Acta Neurochir (Wien) 1999; 141 (07) 721-726 , discussion 726–727
  • 12 Donaldson SS, Laningham F, Fisher PG. Advances toward an understanding of brainstem gliomas. J Clin Oncol 2006; 24 (08) 1266-1272
  • 13 Klimo Jr P, Pai Panandiker AS, Thompson CJ. et al. Management and outcome of focal low-grade brainstem tumors in pediatric patients: the St. Jude experience. J Neurosurg Pediatr 2013; 11 (03) 274-281
  • 14 Cartmill M, Punt J. Diffuse brain stem glioma. A review of stereotactic biopsies. Childs Nerv Syst 1999; 15 (05) 235-237 , discussion 238
  • 15 Kaplan AM, Albright AL, Zimmerman RA. et al. Brainstem gliomas in children. A Children's Cancer Group review of 119 cases. Pediatr Neurosurg 1996; 24 (04) 185-192
  • 16 Chitnavis B, Phipps K, Harkness W, Hayward R. Intrinsic brainstem tumours in childhood: a report of 35 children followed for a minimum of 5 years. Br J Neurosurg 1997; 11 (03) 206-209
  • 17 Gropper MR, Schulder M, Duran HL, Wolansky L. Cerebral tuberculosis with expansion into brainstem tuberculoma. Report of two cases. J Neurosurg 1994; 81 (06) 927-931
  • 18 Kumar R, Jain R, Kaur A, Chhabra DK. Brain stem tuberculosis in children. Br J Neurosurg 2000; 14 (04) 356-361
  • 19 Kumar R, Singhi V. Tuberculous brain stem abscesses in children. Case report. J Pediatr Neurol 2004; 2 (02) 101-106
  • 20 Kumar R, Pandey CK, Bose N, Sahay S. Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children). Childs Nerv Syst 2002; 18 (3-4): 118-123
  • 21 Mai JC, Ramanathan D, Kim LJ, Sekhar LN. Surgical resection of cavernous malformations of the brainstem: evolution of a minimally invasive technique. World Neurosurg 2013; 79 (5-6): 691-703
  • 22 Lee JW, Kim DS, Shim KW. et al. Management of intracranial cavernous malformation in pediatric patients. Childs Nerv Syst 2008; 24 (03) 321-327
  • 23 Huang PP, Zagzag D, Benjamin V. Intracranial schwannoma presenting as a subfrontal tumor: case report. Neurosurgery 1997; 40 (01) 194-197
  • 24 Gross BA, Batjer HH, Awad IA, Bendok BR, Du R. Brainstem cavernous malformations: 1390 surgical cases from the literature. World Neurosurg 2013; 80 (1-2): 89-93
  • 25 Fried I, Hawkins C, Scheinemann K. et al. Favorable outcome with conservative treatment for children with low grade brainstem tumors. Pediatr Blood Cancer 2012; 58 (04) 556-560