Interdisciplinary Neurosurgery (Jun 2022)

Childhood brainstem gliomas: A non-aggressive management

  • Nourou Dine Adeniran Bankole, MD,
  • Yao Christian Hugues Dokponou, MD,
  • Milena Christine Sayore, MD,
  • Mahjouba Boutarbouch, MD,
  • Loubna Rifi, MD PhD,
  • Abdesamad El Ouahabi, MD

Journal volume & issue
Vol. 28
p. 101488

Abstract

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Backgrounds: Childhood primary brain tumors, including brainstem gliomas, are a diverse group of conditions that constitute the most common solid tumor in the pediatric population with many management challenges in LMICs. Objective: Our study aims to suggest a consensus for non-aggressive management for Pediatric brainstem gliomas. Methods: This is a retrospective study at the Neurosurgery department of l’Hôpital Des Spécialités Rabat. All children with Brainstem glioma managed from January 2008 to April 2020. Results: Seventeen patients with Brainstem glioma were managed during the study period and were included in this analysis. Patients were 7.1 years old (median) [IQR: 1.3–17] at diagnosis, and 65% were boys. Diffuse intrinsic pontine glioma Type I was strongly retained on MRI in eight cases (47%) versus 9 cases (53%) of FBSG in our cases. Multidisciplinary joint concertation between pediatric neuro-oncologists and neurosurgeons was done for therapeutic decision-making. Stereotaxic biopsy (STB) with Leksell frame was performed in five cases of FBSG (29.41%) to have pathology, and four patients of FBSG (23.52%) had a focal resection with high extent resection >90%. We sent the 8 cases of DIPG to the neuro-oncology department for management. Three (37,5%) of them benefited from CSF shunt before. Histo-pathology with Immunohistochemistry revealed pilocytic astrocytoma (33%; n= 03), gangliogliomas infiltrating the brainstem (23%; n= 02), anaplastic astrocytoma (33%; n=03) and oligodendroglioma Grade III of WHO (11%; n=1).One case (20%) of focal hematoma occurred after Stereotaxic biopsy without clinical worsening. For DIPG, the median survival time was nine months (IQR: 5-16), whereas the median survival time was 28,5 months(IQR: 13 to 65,3) in FBSG cases. Conclusion: In the case of brainstem glioma, we suggest not harming the child's brainstem by performing safe focal resection or STB on FBSG and referring DIPG patients to neuro-oncology for management.

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