Surgical treatment of localized brainstem gliomas in children with multimodality techniques

Abstract

Objective To discuss the effect of microsurgical treatment for children's focal brainstem gliomas with the assistance of neurophysiological monitoring and multimodal neuronavigation technology. Methods A retrospective analysis was conducted on 42 cases of focal brainstem glioma that were admitted to Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January 2012 to December 2016. During surgery, MRI and DTI (diffusion tensor imaging) data were transferred to the neuronavigator for three-dimensional reconstruction. Tumor resection was performed with the assistance of intraoperative neuronavigation and neuroelectrophysiological monitoring. 19 patients underwent radiotherapy and/or chemotherapy following tumor resection. Results Among all 42 patients, gross total resection was achieved in 38 (90.5%) cases and partial resection in 4 (9.5%) cases. Major postoperative complications included edema of brain stem (n=3, 7.1%), respiratory disorder (n=1, 2.4%) and injury of posterior cranial nerves (n=4, 9.5%) and were relieved following treatment. There was no perioperative death. The follow-up period varied from 6 to 48 months with an average of 34.0±10.1 months. At the last follow-up study, the average Karnofsky performance score was 90.0±9.2 which was significantly higher (P<0.01) than that before surgery (60.0±16.9). During the follow-up, 4 cases showed tumor progression and included 3 deaths. The total survival rate was 92.9% (39/42). Conclusions Microsurgery should be considered for children of focal brainstem gliomas with clear indications. DTI multimodal navigation and intraoperative electrophysiological monitoring could help improve the excision degree of the glioma, reduce surgical trauma and decrease the rates of disability and morality. Key words: Brain stem neoplasms; Glioma; Child; Microsurgery; Neuronavigation; Diffusion tensor imaging; Neurophysiology monitoring; Focal