J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679798
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

Management of Intrinsic Brainstem Lesions in a Developing Country: Difficulties and Pitfalls

Ahmed Farhoud
1   Alexandria University, Alexandria Governorate, Egypt
› Author Affiliations
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Publication History

Publication Date:
06 February 2019 (online)

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    Introduction: Surgery for intra-axial brain stem tumors belong to the most difficult neurosurgical challenges especially when performed with the limited resources of a developing country.

    Methods: We reviewed the outcome of 72 cases surgically treated for intrinsic brain stem lesions between 2008 and 2016. This cohort could be classified into 2 groups; 48 cases of brain stem glioma (BSG) and 24 cases of brain stem cavernoma (BSC). The mean follow-up period was 31 months. Intraoperative image guidance was lacking in all our cases and electrophysiological monitoring was available in 47 cases

    Results: The first group included 29 children and 19 adults harboring BSG with a mean age of 21 years. They underwent 63 surgical procedures at our institute: 57 procedures were for tumor resection, 5 were for CSF diversion and the one for the evacuation of a subdural hygroma. Total resection was achieved in 17 out of 57 procedures for tumor resection (29.8%). The most common pathology was pilocytic astrocytoma (49%). There were 2 postoperative mortalities in this group and 4 cases had permanent postoperative worsening of their neurological status.

    The 2nd group included 23 adults and one child with a mean age of 34 years. All patients in this group suffered from at least 2 significant hemorrhagic episodes prior to surgery. There was a single postoperative mortality in this group. At 1-year follow-up, 9 cavernoma patients (37.5%) showed improvement compared with their preoperative neurological status, 10 patients (41.7%) had no change, and 4 patients (16.7%) were neurologically worse than their preoperative status.

    Conclusion: Despite its associated risks, surgery remains the primary therapeutic option for focal BSGs and symptomatic BSCs. Modern diagnostic and surgical tools are useful in reducing these risks; however, proper patient selection and meticulous microsurgical techniques represent the basis for satisfactory results


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    No conflict of interest has been declared by the author(s).