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Brainstem glioma

David T Fernandes Cabral, Georgios A Zenonos, Maximiliano Nuñez, Pinar Celtikci, Carl Snyderman, Eric Wang, Paul A Gardner, Juan C Fernandez-Miranda
BACKGROUND: The endoscopic endonasal approach (EEA) has been proposed as a potential alternative for ventral brainstem lesions. The surgical anatomy, feasibility, and limitations of the EEA for intrinsic brainstem lesions are still poorly understood. OBJECTIVE: To describe the surgical planning, anatomy, and technique of an intrinsic pontine glioma operated via EEA. METHODS: Six-human brainstems were prepared for white matter microdissection...
March 12, 2018: Operative Neurosurgery (Hagerstown, Md.)
Bernard Florian, Jean-Michel Lemée, Rogatien Faguer, Henri-Dominique Fournier
BACKGROUND: The radiological signs of intracranial dural arteriovenous fistulas (ICDAVFs) are heterogenous. While it is commonly accepted that hyper intense T2 Wedge MRI of the brainstem and cervical cord mainly concern gliomas, it is so far uncommon and probably unknown that ICDAVFs can imitate similar radiological pattern, especially with gadolinium contrast enhancement and cord enlargement. Thus the angiography is poorly documented in the diagnostic work-up. CASE: We report the unusual history of ICDAVFs, revealed by clinical and radiological features that mimicked a medulla or cervical spinal cord glioma...
March 7, 2018: World Neurosurgery
Suyash Singh, Kuntal Kanti Das, Sushila Jaiswal, Raj Kumar
BACKGROUND: Exophytic growth (EG), where in the tumor mass grows beyond the neuraxial boundary formed by pia mater, remains a rare pattern of glioma growth. It has been described in gliomas at several locations like the brainstem, cerebellum, suprasellar area, spinal cord and the insula. However, EG in hemispheric grade 2 astrocytomas, particularly affecting the convexity subarachnoid space, as against the more spacious basal subarachnoid space, is exceedingly rare. To the best of our knowledge, there is only one such case reported in the English literature...
February 15, 2018: World Neurosurgery
Abdulrahman Abdullah Albatly, Adnan Taleb Alsamarah, Abdulrahman Alhawas, Patrick Veit-Haibach, Alfred Buck, Paul Stolzmann, Irene A Burger, Spyros S Kollias, Martin W Huellner
PURPOSE: To investigate 18 F-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) imaging characteristics of adult brainstem glioma (BSG). MATERIALS AND METHODS: FET-PET imaging and progression-free survival (PFS) of 16 adult patients with BSG was analyzed (9 high-grade gliomas, 7 low-grade gliomas). SUV max , TBR, and time activity curves of FET-PET were calculated. RESULTS: Progressive gliomas had higher SUV max (3.57 ± 1.47 vs...
February 8, 2018: Clinical Imaging
Elena V Daoud, Veena Rajaram, Chunyu Cai, Robert J Oberle, Gregory R Martin, Jack M Raisanen, Charles L White, Chan Foong, Bruce E Mickey, Edward Pan, Kimmo J Hatanpaa
Adult brainstem gliomas are difficult to classify based on radiologic and histologic features. A K27M mutation in histone 3 has been described to identify high-grade midline gliomas associated with a particularly unfavorable prognosis. While initially considered a pediatric entity, it is now known that H3K27M-mutant brainstem gliomas occur in all age groups, but they are less well understood in adults. We studied clinical, radiologic, and pathologic features of 25 brainstem gliomas diagnosed at our institution between 1994 and 2017 in subjects at least 18 years old...
February 10, 2018: Journal of Neuropathology and Experimental Neurology
Tabitha Cooney, Paul G Fisher, Li Tao, Christina A Clarke, Sonia Partap
The objective of this study was to investigate racial/ethnic differences in survival for pediatric high-grade glioma (HGG) and medulloblastoma in the state of California. We obtained data from the California Cancer Registry on 552 high-grade glioma patients (110 brainstem, 442 non-brainstem) and 648 medulloblastoma patients ages 0-19 years from 1988 to 2012. Using multivariate Cox proportional hazards regression, we examined the impact of individual and neighborhood characteristics on survival. Socioeconomic quintile and insurance status differed significantly by race for both diagnoses...
February 7, 2018: Journal of Neuro-oncology
L M Smyth, P A W Rogers, J C Crosbie, J F Donoghue
Synchrotron microbeam radiation therapy is a promising preclinical radiotherapy modality that has been proposed as an alternative to conventional radiation therapy for diseases such as diffuse intrinsic pontine glioma (DIPG), a devastating pediatric tumor of the brainstem. The primary goal of this study was to characterize and compare the radiosensitivity of two DIPG cell lines (SF7761 and JHH-DIPG-1) to microbeam and conventional radiation. We hypothesized that these DIPG cell lines would exhibit differential responses to each radiation modality...
February 2018: Radiation Research
Javier E Villanueva-Meyer, Matthew D Wood, Byung Se Choi, Marc C Mabray, Nicholas A Butowski, Tarik Tihan, Soonmee Cha
OBJECTIVE: Grade II diffuse gliomas (DGs) with isocitrate dehydrogenase (IDH) mutations are associated with better prognosis than their IDH wild-type counterparts. We sought to determine the MRI characteristics associated with IDH mutational status and ascertain whether MRI considered in combination with IDH mutational status can better predict the clinical outcomes of grade II DGs. MATERIALS AND METHODS: Preoperative MRI examinations were retrospectively studied for qualitative tumor characteristics, including location, extent, cortical involvement, margin sharpness, cystic component, mineralization or hemorrhage, and contrast enhancement...
December 20, 2017: AJR. American Journal of Roentgenology
Kunal S Patel, Bob S Carter, Clark C Chen
Gliomas encompass a wide spectrum of various histopathological entities with different management strategies and associated prognoses. In many cases, initial biopsy of the brain lesion is required, since definitive diagnosis forms the foundation for treatment decision-making. Tissue sampling can be attained during stereotactic, open, or endoscopic procedures and, overall, provides >90% diagnostic yield, while it may be significantly lower (60-70%) in small (<1 cm3) and/or heterogeneous lesions. In the majority of the modern series, the morbidity rates do not exceed 2...
2018: Progress in Neurological Surgery
James A Balogun, James T Rutka
Gliomas are the most common type of brain cancer in the pediatric patients, constituting about 50% of all childhood intracranial tumors. This is a highly heterogeneous group, varying from the benign WHO histopathological grades I and II to malignant WHO grades III and IV. The histology and location are significant prognostic factors, which influence the decision for surgical intervention, as well as the extent of possible tumor removal. In low-grade gliomas, surgery remains the initial option and should be directed at gross total resection in favorable locations, such as the cerebral hemispheres and the cerebellum...
2018: Progress in Neurological Surgery
Tomokatsu Hori, Atsushi Ishida, Yasuo Aihara, Seigo Matsuo, Haruko Yoshimoto, Hideki Shiramizu
Management of deep-seated and midline gliomas originating from thalamus, hypothalamus, basal ganglia, and brainstem presents significant challenges. Aggressive resection of such tumors is frequently impossible due to excessive morbidity and mortality rates; thus, combinations of both surgical and non-surgical treatment options should be always considered. In each individual case, there should be reasonable clinical judgment with regard to the optimal outcome providing the best possible prognosis for the patient, with high quality of life and minimal risk of complications...
2018: Progress in Neurological Surgery
Taiichi Saito, Manabu Tamura, Mikhail F Chernov, Soko Ikuta, Yoshihiro Muragaki, Takashi Maruyama
Aggressive resection of intracranial gliomas has a positive impact on patients' prognosis, but is associated with a risk of neurological complications. For preservation of brain functions and avoidance of major postoperative morbidity various methods of intraoperative neurophysiological monitoring have been introduced into clinical practice. At present, somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP), and electrocorticography (ECoG) are used routinely during neurosurgical procedures...
2018: Progress in Neurological Surgery
Jing-Jing Ge, Cheng Li, Jun-Ping Zhang
BACKGROUND: There is no standard salvage treatment for recurrent and/or unresectable brainstem low-grade gliomas after failure from carboplatin and vincristine chemotherapy. Recombinant human endostatin (rh-ES), a mild inhibitor of angiogenesis, has been used for treating lung cancer. But so far as we know, there is no experience for brainstem gliomas. CASE DESCRIPTION: The authors present a pediatric case of recurrent brainstem pilocytic astrocytoma with neuraxis dissemination who experienced tumor progression with carboplatin and vincristine chemotherapy but then had a dramatic and long-term remission for at least 29 months after combined treatment of rh-ES with carboplatin and vincristine...
February 2018: World Neurosurgery
Ho-Shin Gwak, Hyeon Jin Park
Prognosis of diffuse intrinsic pontine glioma (DIPG) is poor, with a median survival of 10 months after radiation. At present, chemotherapy has failed to show benefits over radiation. Advances in biotechnology have enabled the use of autopsy specimens for genomic analyses and molecular profiling of DIPG, which are quite different from those of supratentorial high grade glioma. Recently, combined treatments of cytotoxic agents with target inhibitors, based on biopsied tissue, are being examined in on-going trials...
December 2017: Critical Reviews in Oncology/hematology
L M Smyth, P A W Rogers, J C Crosbie, J F Donoghue
Synchrotron microbeam radiation therapy is a promising preclinical radiotherapy modality that has been proposed as an alternative to conventional radiation therapy for diseases such as diffuse intrinsic pontine glioma (DIPG), a devastating pediatric tumor of the brainstem. The primary goal of this study was to characterize and compare the radiosensitivity of two DIPG cell lines (SF7761 and JHH-DIPG-1) to microbeam and conventional radiation. We hypothesized that these DIPG cell lines would exhibit differential responses to each radiation modality...
November 30, 2017: Radiation Research
Andra Valentina Krauze, Cord Peters, Jason Cheng, Holly Ning, Megan Mackey, Lindsay Rowe, Theresa Cooley-Zgela, Dee Dee Smart, Kevin Camphausen
PURPOSE/OBJECTIVES: Despite mounting evidence for the use of re-irradiation (re-RT) in recurrent high grade glioma, optimal patient selection criteria for re-RT remain unknown. We present a novel scoring system based on radiobiology principles including target independent factors, the likelihood of target control, and the anticipated organ at risk (OAR) toxicity to allow for proper patient selection in the setting of recurrent glioma. MATERIALS/METHODS: Thirty one patients with recurrent glioma who received re-RT (2008-2016) at NCI - NIH were included in the analysis...
November 29, 2017: Radiation Oncology
Nundia Louis, Sharon Liu, Xingyao He, Daryl C Drummond, Charles O Noble, Stewart Goldman, Sabine Mueller, Krystof Bankiewicz, Nalin Gupta, Rintaro Hashizume
Despite the advances in imaging, surgery and radiotherapy, the majority of patients with brainstem gliomas die within 2 years after initial diagnosis. Factors that contribute to the dismal prognosis of these patients include the infiltrative nature and anatomic location in an eloquent area of the brain, which prevents total surgical resection and the presence of the blood-brain barrier (BBB), which reduces the distribution of systemically administered agents. The development of new therapeutic approaches which can circumvent the BBB is a potential path to improve outcomes for these children...
February 2018: Journal of Neuro-oncology
Yashar Moharamzad, Morteza Sanei Taheri, Farhad Niaghi, Elham Shobeiri
Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years)...
January 1, 2017: Neuroradiology Journal
Yang Zhang, Changcun Pan, Junmei Wang, Jingli Cao, Yuhan Liu, Yajie Wang, Liwei Zhang
We surveyed common genetic mutations (IDH1, H3F3A, PPM1D, and TP53) and immune features (PD-L1 expression and CD8(+) T cell tumor infiltration) in a series of 62 malignant brainstem gliomas that were resected via microsurgery. IDH1 mutations were mutually exclusive with H3F3A mutations. IDH1 mutations appeared only in adults and occurred more frequently in tumors larger than 10cm(3) (8/29 vs 1/32, Fisher's exact test, p=0.010). H3F3A mutations occurred more frequently in children and adolescent patients (19/24 vs 18/38, chi-square test, p=0...
October 10, 2017: Oncotarget
Yaqin Zhang, Weijie Dong, Junying Zhu, Lizhu Wang, Xinjian Wu, Hong Shan
Background: Diffuse intrinsic pontine glioma is an infiltrative, often high-grade glioma of the brainstem that is not amenable to surgical resection. The current treatment of DIPG by radiation therapy showed dramatically improvement of patient's condition, however, the tumor recurs rapidly. More and more studies are focused on the genetic and epigenetic drivers of DIPGs, which may provide more and more novel therapy target for DIPG. EZH2 has been proved to be a potential therapeutic target for H3K27M-mutant pediatric gliomas recently...
2017: Cell & Bioscience
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