Brainstem Gliomas In Children Research Articles

Bibliometric analysis of emerging trends and research foci in brainstem tumor field over 30years (1992-2023).

Over the past several decades, numerous articles have been published on brainstem tumors. However, there has been limited bibliometric analysis in this field. Therefore, we conducted a bibliometric analysis to elucidate the evolution and current status of brainstem tumor research. We retrieved 5525 studies published in English between 1992 and 2023 from the Web of Science Core Collection database. We employed bibliometric tools and VOSviewer to conduct the analysis. We included a total of 5525 publications for further analysis. The annual publications have exhibited steady growth over time. The United States accounted for the highest number of publications and total citations. Among individual researchers, Liwei Zhang had the highest number of publications, while Cynthia Hawkins and Chris Jones shared the most citations, closely followed by Eric Bouffet in this field. The study titled "Diffuse brainstem glioma in children: critical review of clinical trials" stood out as the most cited work in this field. Keyword analysis revealed that immune therapy and epigenetic research are the focal points of this field. Our bibliometric analysis underscores the enduring significance of brainstem tumors in the realm of neuro-oncology research. The field's hotspots have transitioned from surgery and radiochemotherapy to investigating epigenetic mechanisms and immune therapy.

Retracted: Prediction of Cancer‐Specific Survival of Brainstem Glioma in Children Based on Risk Stratification Model

Retracted: Prediction of Cancer‐Specific Survival of Brainstem Glioma in Children Based on Risk Stratification Model

Prediction of Cancer-Specific Survival of Brainstem Glioma in Children Based on Risk Stratification Model.

Objective To develop and authenticate a risk stratification framework and nomogram for ascertaining cancer-specific survival (CSS) among the pediatric brainstem gliomas. Methods For patients less than 12 years, according to Surveillance, Epidemiology, and End Results (SEER), information from 1998 to 2016 is found in their databases. The survival outcomes, treatments, and demographic clinicopathologic conditions are scrutinized per the database validation, and training cohorts are divided and validated using multivariate Cox regression analysis. A nomogram was designed, and predominantly, the risk stratification conceptualization engaged selected tenets according to the multivariate analysis. The model's authenticity was substantiated through C-index measure and calibration curves. Results There are 806 pediatric concerns of histologically concluded brainstem glioma in the research. According to multivariate analysis, age, grade, radiotherapy, and race (with P value < 0.05) depicted independent prognostic variations of the pediatric gliomas. The nomogram's C-index was approximately 0.75 and an accompanied predictive capability for CSS. Conclusion The nomogram constructed in this glioma's context is the primary predictor of using risk stratification. A combination of nomograms with the risk stratification mechanism assists clinicians in monitoring high-risk individuals and engage targeted accessory treatment.

Very long-term of survival, 5 years and more in diffuse intrinsic pontine brainstem gliomas in children and adolescents treated with Radiotherapy and Nimotuzumab

Diffuse intrinsic brainstem gliomas have a bad prognosis, and short-term survival time. Radiotherapy has been the principal treatment, and chemotherapy has not improved outcome. The anti –EGFR monoclonal antibody Nimotuzumab combined with Radiotherapy was tested in a series of 41 children and adolescents with diffuse intrinsic pontine gliomas (DIPG) included between January 2008 and December 2015 and a follow-up till January 2021.They were irradiated in the Instituto Nacional de Oncologia y Radiobiologia, Havana, Cuba with a median dose of 54 Gy. Nimotuzumab was applied at a dose of 150 mg/m2, weekly during the period of irradiation, then every 2 weeks by 8 doses, and them monthly for 1,2 or more years. A response was observed in 87.8% of patients. Prolonged use of Nimotuzumab was feasible and well tolerated. Median age at diagnosis was 7 years old, median survival was 18.8 months. There were minor toxicities, only Grade I or II. Survival rate at 5 years was 34.1%, stablished till years or more. Two relapsing patients were re-irradiated. The combination of irradiation and Nimotuzumab is an option to increase survival in DIPG.

H3.3-K27M drives neural stem cell-specific gliomagenesis in a human iPSC-derived model.

Diffuse intrinsic pontine glioma (DIPG) is an aggressive childhood tumor of the brainstem with currently no curative treatment available. The vast majority of DIPGs carry a histone H3 mutation leading to a lysine 27-to-methionine exchange (H3K27M). We engineered human induced pluripotent stem cells (iPSCs) to carry an inducible H3.3-K27M allele in the endogenous locus and studied the effects of the mutation in different disease-relevant neural cell types. H3.3-K27M upregulated bivalent promoter-associated developmental genes, producing diverse outcomes in different cell types. While being fatal for iPSCs, H3.3-K27M increased proliferation in neural stem cells (NSCs) and to a lesser extent in oligodendrocyte progenitor cells (OPCs). Only NSCs gave rise to tumors upon induction of H3.3-K27M and TP53 inactivation in an orthotopic xenograft model recapitulating human DIPGs. In NSCs, H3.3-K27M leads to maintained expression of stemness and proliferative genes and a premature activation of OPC programs that together may cause tumor initiation.

The Role of Apparent Diffusion Coefficient in the Differentiation between Cerebellar Medulloblastoma and Brainstem Glioma.

For certain clinical circumstances, the differentiation between cerebellar medulloblastoma and brainstem glioma is essential. We aimed to evaluate the role played by the apparent diffusion coefficient (ADC) values in the differentiation between cerebellar medulloblastomas and brainstem gliomas in children. The institutional review board approved this prospective study. Brain magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and ADC, was assessed in 32 patients (median age: 7.0 years), divided into two groups, a medulloblastoma group (group 1, n = 22) and a brainstem glioma group (group 2, n = 10). The Mann–Whitney U test was utilized to compare tumor ADCmax, ADCmin, ADCmean, and ADCsd values, and their ratios with the parenchyma values between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to calculate the cut-off value, along with the area under the curve (AUC), sensitivity, and specificity. The median ADCmax, ADCmin, and ADCmean values were significantly higher in group 2 than in group 1 (p < 0.05). The median ratios of ADCmin and ADCmean to the parenchyma were significantly higher in group 2 than in group 1 (p < 0.05). The ROC analysis showed that the AUC for the ADCmean ratio was the highest among these parameters, at 98.2%. The ADCmean tumor to parenchyma ratio was a significant and effective parameter for the differentiation between pediatric medulloblastomas and brainstem gliomas.

Surgical treatment and prognosis of focal brainstem gliomas in children: A 7 year single center experience.

This study aims to describe the role of open surgical treatment for focal brainstem gliomas (FBSGs) with the assistance of multimodal neuronavigation and intraoperative neurophysiological monitoring (IOM) in children to investigate the efficacy of microsurgical treatment in pediatric FBSGs. Also the prognostic factors related to the overall survival (OS) of FBSGs to describe the patient and tumor characteristics relevant to prognosis/outcome were focused on. Clinical data of 63 pediatric patients below 16 years of age with FBSGs admitted to the Neurosurgical Unit of Beijing Tiantan Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients underwent initial surgical treatment, followed by magnetic resonance diffusion tensor imaging (DTI), neuronavigation and IOM. Gross or near total resection (GTR or NTR) was achieved in 57/63 (90.5%) cases, and subtotal resection (STR) was achieved in 6/63 (9.5%) cases. Postoperative adjuvant therapy was received by 27/63 (42.9%) cases. Postoperative pathological examination revealed that 36/63 (57.1%) cases had grade I gliomas, 22/63 (34.9%) had grade II, and 5/63 (8.0%) had grade III–IV gliomas according to the WHO classification. The mean Karnofsky score preoperatively was 60, and at the time of follow-up was 90. Consecutively, 6 cases demonstrated disease progression, and 5 of these were deceased. The OS in all patients was 81.2% at 5 years. Histological grade (P < .001) and age at diagnosis (P = .023) showed significant association with prolonged OS. Multimodal neuronavigation and IOM allow very precise intracranial surgery, contributing to a maximally safe resection that might decrease the postoperative disability and mortality rate. This study also showed that pediatric FBSGs were mostly low-grade tumors with excellent surgical outcomes. Consequently, it is suggested that microsurgery can be used to treat FBSGs in children in order to provide better prognosis and survival outcomes.

Long term survival in diffuse infiltrative brainstem gliomas in children and adolescents treated with radiotherapy and Nimotuzumab

Objectives This study is devoted to the evaluation of the possibility and effectiveness of re irradiation treatment of children and adolescents with the relapses of diffusely growing brainstem tumor BST Methods Repeated radiotherapy was performed in patients aged from to years who had a relapse of a BST in terms from months to years after the first curses radiation treatment in doses of Gy In the case of re irradiation single fractions of Gy were used five times a week to total doses from to Gy Results The tolerability of repeated irradiation was satisfactory Improvement of the condition of the patients was achieved in the condition of the three patients did not change and the two worsened which caused the interruption of treatment at a dose of and Gy On further observation children died of progression of the tumor in a period of to months their median life expectancy was months Three patients dropped out of observation and two were alive for years and years after re irradiation with residual neurologic disorders with the tumor residue detected on the MRI without signs of radiation necrosis Both had a pilocitic astrocytoma Conclusion Repeated radiotherapy for the relapse of BST can improve the quality of life for most children and provide a long term stabilization of tumor growth in low grade gliomas

Long term survival in diffuse infiltrative brainstem gliomas in children and adolescents treated with radiatherapy and Nimotuzumab

Background Brainstem gliomas have a short survival time chemotherapy has not improved outcome We report the result obtained with the combination of Radiotherapy and the monoclonal antibody Nimotuzumab in a series of these tumors Material and methods children and adolescents treated with irradiation and Nimotuzumab were included between Jan and December all with the diagnosis of diffuse infiltrative pontine gliomas DIPG irradiated at the Instituto Nacional de Oncologia y Radiobiologia in Havana Cuba Nimotuzumab was applied during the period receiving Radiotherapy and them monthly for one year or more Results Median age at diagnosis was years range years old median survival was months and Kaplan Meier survival was at years and at years established till years Addition of Nimotuzumab was safe and well tolerated Conclusion Combination of Nimotuzumab and Radiotherapy is safe and could increase survival

Surgical treatment of localized brainstem gliomas in children with multimodality techniques

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

A multi-institutional study of brainstem gliomas in children with neurofibromatosis type 1.

To define the clinical and radiologic features of brainstem gliomas (BSGs) in children with neurofibromatosis type 1 (NF1). We performed a retrospective cross-sectional study of 133 children with NF1 and concurrent BSGs cared for at 4 NF1 referral centers. BSG was determined using radiographic criteria. Age at diagnosis, tumor location and appearance, clinical symptoms, treatment, and presence of a concurrent optic pathway glioma were assessed. The average age at BSG diagnosis was 7.2 years, and tumors occurred most often in the midbrain and medulla (66%). The majority of children with NF1-BSGs were asymptomatic (54%) and were not treated (88%). Only 9 of the 72 asymptomatic children received treatment because of progressive tumor enlargement. In contrast, 61 children presented with clinical signs/symptoms attributable to their BSG; these individuals were older and more often had focal lesions. Thirty-one patients underwent treatment for their tumor, and 14 received CSF diversion only. Progression-free survival was ∼3 years shorter for children receiving tumor-directed therapy relative to those who had either no treatment or CSF diversion only. Overall survival was 85% for the tumor-directed therapy group, whereas no deaths were reported in the untreated or CSF diversion groups. Unlike children with sporadically occurring BSGs, most children with NF1-BSGs were asymptomatic, and few individuals died from complications of their tumor. Those requiring tumor-directed treatment tended to be older children with focal lesions, and had clinically more aggressive disease relative to those who were not treated or underwent CSF diversion only.

Radiotherapy for diffuse brainstem glioma in children and young adults.

Diffuse brainstem glioma is a devastating disease with very poor prognosis. The most commonly used radiological treatment is conventional fractionated radiation. So far, there is no meta-analysis or systematic review available that assesses the benefits or harms of radiation in people with diffuse brainstem glioma. To assess the effects of conventional fractionated radiotherapy (with or without chemotherapy) versus other therapies (including different radiotherapy techniques) for newly diagnosed diffuse brainstem gliomas in children and young adults aged 0 to 21 years. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and EMBASE to 19 August 2015. We scanned conference proceedings from the International Society for Paediatric Oncology (SIOP), International Symposium on Paediatric Neuro-Oncology (ISPNO), Society of Neuro-Oncology (SNO), and European Association of Neuro-Oncology (EANO) from 1 January 2010 to 19 August 2015. We searched trial registers including the International Standard Randomised Controlled Trial Number (ISRCTN) Register, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the register of the National Institutes of Health to 19 August 2015. We imposed no language restrictions. All randomised controlled trials (RCTs), quasi-randomised trials (QRCTs), or controlled clinical trials (CCTs) that compared conventional fractionated radiotherapy (with or without chemotherapy) versus other therapies (including different radiotherapy techniques) for newly diagnosed diffuse brainstem glioma in children and young adults aged 0 to 21 years. Two review authors independently screened studies for inclusion, extracted data, assessed the risk of bias in each eligible trial, and conducted GRADE assessment of included studies. We resolved disagreements through discussion. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We identified two RCTs that fulfilled our inclusion criteria. The two trials tested different comparisons.One multi-institutional RCT included 130 participants and compared hyperfractionated radiotherapy (six-week course with twice a day treatment of 117 cGy per fraction to a total dose of 7020 cGy) with conventional radiotherapy (six-week course with once a day treatment of 180 cGy per fraction to a total dose of 5400 cGy). The median time overall survival (OS) was 8.5 months in the conventional group and 8.0 months in the hyperfractionated group. We detected no clear evidence of effect on OS or event-free survival (EFS) in participants receiving hyperfractionated radiotherapy compared with conventional radiotherapy (OS: hazard ratio (HR) 1.07, 95% confidence interval (CI) 0.75 to 1.53; EFS: HR 1.26, 95% CI 0.83 to 1.90). Radiological response (risk ratio (RR) 0.94, 95% CI 0.54 to 1.63) and various types of toxicities were similar in the two groups. There was no information on other outcomes. According to the GRADE approach, we judged the quality of evidence to be low (i.e. further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate) for OS and EFS, and very low (i.e. we are very uncertain about the estimate) for radiological response and toxicities.The second RCT included 71 participants and compared hypofractionated radiotherapy (39 Gy in 13 fractions over 2.6 weeks, 3 Gy per fraction) with conventional radiotherapy (54 Gy in 30 fractions over six weeks, 1.8 Gy per fraction). This trial reported a median OS of 7.8 months for the hypofractionated group and 9.5 months for the conventional group. It reported a progression-free survival (PFS) of 6.3 months for the hypofractionated group and 7.3 months for the conventional group. We found no clear evidence of effect on OS (HR 1.03, 95% CI 0.53 to 2.01) or PFS (HR 1.19, 95% CI 0.63 to 2.22) in participants receiving hypofractionated radiotherapy when compared with participants receiving conventional radiotherapy. The mainly observed adverse effect was local erythema and dry desquamation especially behind the auricles. There were some other toxicities, but there was no statistically significant difference between treatment groups. There was no information on other outcomes. We judged the quality of evidence to be moderate (i.e. further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate) for OS, and low for PFS and toxicities. It should be mentioned that the sample size in this RCT was small, which could lead to insufficient statistical power for a clinically relevant outcome. We could make no definitive conclusions from this review based on the currently available evidence. Further research is needed to establish the role of radiotherapy in the management of newly diagnosed diffuse brainstem glioma in children and young adults. Future RCTs should be conducted with adequate power and all relevant outcomes should be taken into consideration. Moreover, international multicentre collaboration is encouraged. Considering the potential advantage of hypofractionated radiotherapy to decrease the treatment burden and increase the quality of remaining life, we suggest that more attention should be paid to hypofractionated radiotherapy.

Radiotherapy for brainstem gliomas in children and adults: A single-institution experience and literature review.

To evaluate the treatment results of radiotherapy (RT) in children and adults with brainstem gliomas (BSGs) and review the previous literature. Thirty patients (14 children, 16 adults) with BSG treated using RT were retrospectively evaluated. The median ages of the children and adults were 8 years (range: 2-16 years) and 49 years (range: 19-75 years), respectively. A histological diagnosis was obtained in 11 patients. The median total radiation dose was 56 Gy (range: 50-70 Gy) with a single fraction size of 1.8-2.0 Gy. Temozolomide was administered concurrently with RT in 14 patients. Tumor progression after RT occurred in 26 patients (14 children and 12 adults). Four adults survived without tumor progression. The median survival times for children and adults were 8.5 and 39 months, respectively. The 1-, 2- and 3-year overall survival rates for children/adults were 29%/75%, 14%/68% and 0%/53%, respectively (P = 0.001), and the 1-, 2- and 3-year progression-free survival rates for children/adults were 14%/69%, 0%/49% and 0%/35%, respectively (P < 0.001). Grade 3 or higher acute and late toxicities did not occur. In this study, the prognosis of children with BSGs was considerably poorer than that of adults, and our results are consistent with those of previous studies. Efforts should be made to improve the survival outcomes of patients with BSGs, especially children.

Temozolomide in the treatment of newly diagnosed diffuse brainstem glioma in children: a broken promise?

Background:The purpose of this study was to assess the efficacy and toxicity of radiotherapy (RT) with concurrent temozolomide (TMZ) chemotherapy followed by adjuvant TMZ in children with diffuse intrinsic pontine glioma (DIPG).Methods:Patients younger than 18 years with newly diagnosed DIPG were enrolled. Children were treated with focal RT along with concurrent daily TMZ. Four weeks after completing the initial RT–TMZ schedule, adjuvant TMZ was given every 28 days up to 12 cycles or progression disease.Results:Fifteen children with a median age of 9 years were enrolled. Fourteenth out of the 15 patients completed the chemoradiotherapy. The toxicity associated with TMZ was primarily haematopoietic. At a median follow-up of 15 months 13 children had died and 2 children were alive with progressive disease. No patient experienced complete response (CR). The median time to progression was 7·15 months.Conclusion:Chemoradiotherapy with TMZ followed by adjuvant TMZ did not improve the poor prognosis associated with DIPG in children.

Histologically Proven, Low-grade Brainstem Gliomas in Children

To evaluate long-term overall survival (OS), progression-free survival (PFS), and outcomes in pathologically proven brainstem low-grade gliomas (BS-LGG) in children. The Mayo Clinic tumor registry identified 48 consecutive children (≤20 y, 52% female) with biopsy-proven BS-LGG treated at Mayo Clinic between January 1971 and December 2004. Medical records were retrospectively reviewed. For analysis, patients were censored at the time of recurrence, death, or last follow-up. The median age at diagnosis was 12 years with a median follow-up of 6.0 years. The majority of tumors were grade I (69%) and pathology was consistent with an astrocytoma in the majority of patients (98%). Gross total resection was obtained in 4, subtotal in 17, and 27 patients were biopsied only. Postoperative radiotherapy (RT) was used in 29 patients. Median OS for the entire group was 14.8 years with a 1-, 5-, and 10-year OS of 85%, 67% and 59%, respectively. Median PFS for the entire group was 7.3 years. Improved survival was associated with undergoing resection versus biopsy-only with 5-year OS rates of 85% and 50% (P=0.002), respectively. A high proportion of patients (42%) had diffuse tumors and 13 patients (27%) had diffuse pontine gliomas (DPGs). DPGs had an OS of 1.8 years with a worse median PFS than non-DPGs (1.8 vs. 11.1 y; P=0.009). RT was used preferentially in patients with poor prognosis such as those who had a biopsy-only procedure (19/27) and DPGs (9/13). OS in this single institution retrospective study in pathologically proven BS-LGG with extensive follow-up displayed favorable long-term outcomes. Improved outcomes were associated with nondiffuse classification.

Brainstem Gliomas

Historically, brainstem gliomas have been considered as a single entity. Since the introduction of magnetic resonance (MR) imaging in the late 1980s, these tumors are now regarded as a heterogeneous group of neoplasms with different age of onset, clinical and radiologic presentation, and varying behavior and natural history. This article describes the different subtypes of brainstem gliomas in children and adults. We focus on recent advances in MR such as MR spectroscopy, MR perfusion, and diffusion tensor imaging that often strongly suggest the histopathologic diagnosis of the lesion.

Stereotactic Computed Tomography-guided Biopsy of Brainstem Lesions

Background: Appropriate treatment of brainstem lesions is possible only when an accurate histopathologic diagnosis is made. Stereotactic biopsy has been used extensively to aid the diagnosis and management of intracranial lesions. This study presents the authors’ 18-year experience with diagnostic stereotactic biopsy of brainstem lesions. Methods: Hospital records for all patients with brainstem lesions who underwent stereotactic biopsy at our hospital between 1989 and 2007 were retrospectively reviewed. Results: A stereotactic biopsy for brainstem tumors was performed on 200 patients (61% male) with a mean age of 23.9±16.97 years at the time of diagnosis. Glioma was the most common histopathologic diagnosis in 95.0% of the patients (n=190). Diagnoses in 10 patients included lymphoma (5), abscess (3), adenocarcinoma (1), and multiple sclerosis (1). The mortality was 0.5% and the morbidity was 4.0%: intraparenchymal hemorrhage, 5 cases; perilesional edema, 1 case; hydrocephalus, 1 case; and aspirative pneumonia, 1 case. Conclusions: Although the diverse pathology of brainstem lesions in adults requires an accurate diagnosis for the appropriate treatment strategy, the high incidence of brainstem glioma in children has led to some debate on the usefulness of the stereotactic biopsy in these patients.

Radiation Therapy for Brain Stem Gliomas in Children and Adults

Poster: RANZCR-AOCR 2012 / R-0116 / Radiation therapy for brain stem gliomas in children and adults by: Yoshida, N. S. Sulaiman, H. Nishimura, D. Miyawaki, K. Uehara, T. Sasayama, A. Hayakawa, K. Sugimura, R. Ryohei; JP

Shall we treat hydrocephalus associated to brain stem glioma in children?

Brain stem glioma accounts for 6-9% of brain tumors in children. Tumor progression may lead to CSF pathway obstruction and development of hydrocephalus. We retrospectively reviewed charts of patients consecutively treated in our institution with diffuse intrinsic pontine glioma in order to assess incidence of hydrocephalus, its management, and its impact on overall survival. All patients had brain stem glioma not amenable to surgery. Cases with exophytic brain stem glioma were excluded. Fifty-one children were treated from January 2005 to December 2010 for brain stem glioma in the Pediatric Neurosurgery Department of Necker Enfants Malades, Paris, France. Hydrocephalus occurred in 11 of them (22%). They were six boys and five girls; the average and median time from tumor diagnosis to onset of hydrocephalus were 5.3 and 3.2months, respectively, while average and median time from onset of hydrocephalus to death were 5.3 and 2.8months, respectively. Hydrocephalus was treated in nine patients by a ventriculoperitoneal (VP) shunt and in two patients by an endoscopic third ventriculostomy. Because of early failure, a VP shunt was implanted in one child. The overall 1-year survival rate was 33%. Survival rate of patients with such obstructive hydrocephalus was not significantly different from patients harboring brain stem glioma who did not develop hydrocephalus. Furthermore, hydrocephalus was not related to terminal tumor progression. Considering both risks and benefit of treatment, VP shunt could be proposed, on the base of our experience, as the first option in spite of the apparently obstructive nature of the hydrocephalus associated to a brain stem tumor.

Location, Location, Location

Location, Location, Location