All issues > Volume 34(4); 1991

Original Article

J Korean Pediatr Soc. 1991;34(4):532-543. Published online April 30, 1991.

Clinical observation on brainstem glioma in childhood.

Hyun Jun Cho¹, Se Hee Hwang¹, Yong Seung Hwang¹, In Won Kim²

¹Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
²Department of Radiology, Seoul National University, College of Medicine, Seoul, Korea

Received: September 25, 1990;  Accepted: November 29, 1990.

Abstract

We studied 20 cases with brainstem glioma in childhood who admitted to the Department of Pediatrics and Pediatric Neurosurgery from Oct. 1985 till July 1990. The results were as follows: 1) About 13.5% of all pediatric brain tumors were brainstem gliomas. The mean age on diagnosis was 7.2 years and there was no difference in sex about the incidence and age distribution. 2) The symptom duration until diagnosis was less than 3 months in 80% of patients. 3) The principal clinical findings were multiple cranial neuropathies in all cases, long tract signs in all cases and cerebelllar signs in 75% of children. The most commonly involoved cranial nerves were IX, X, VI. VII, and V in order of frequency. The symptoms of increased intracranial pressure were observed in 30% of patients. 4) The most commonly involoved site in brainstem was pons with midbrain in 55% of cases. 5) The MR imaging was found to be superior method to CT in diagnosis and follow-up of the disease. The diagnosis could be sufficiently made by clinical symptoms and radiologic findings. Biopsy was not always necessary for diagnosis. 6) The most common anatomic type of tumor was diffuse one in 60% of cases. Hydrocephalus and cystic change were observed in 40% and in 50% of cases on radiologic study respectively. CT reveald low or iso density in all cases and MRI showed low or iso signal intensity in all T1 weighted image and high signal intensity in all T2 weighted image. 7) Radiation therapy was done in 90% of patients as single or with other combined treatment. The dose of radiation was 5000 to 5500 rads given directly to the tumor bed over 6-to-7-week period. Transient clinical improvement was achieved in 61.1% of patients after radiation therapy. Subtotal tumor resection was possible in only 1 case of 4 cases that posterior fossa exploration was done. Patholgy was obtained by biopsy in all of those explored 4 cases. Two cases were benign and 2 cases were malignant. 8) The prognosis was very poor, so only 3 patients were alive. Cummulative survival rate till 9 months after diagnosis was 45.0% and median survival time was presumed to be between 8 months and 9 months. (Kaplan-Meier method) 9) Statistical difference was analysed regarding the prognostic factors for survival between the sex, symptom duration until diagnosis, CT appearance, multiplicity of cranial neuropathy, response to RT and tumor size. The survival between patients whose tumor size was less than 3 x 3 x 3 cm and those whose tumor size was extending over 3x3x3cm was significantly different. (p<0.05, Gehan’s generalized Wilcoxon test)

Keywords :Brainstem glioma