Brainstem Glioma

Steven H. Lin and Ori Shokek

 Background

What is the prevalence of brainstem gliomas (BSGs) in relation to pediatric CNS tumors overall?

BSGs comprise 10% of pediatric CNS tumors (<2% of adult CNS tumors).

What is the peak age of presentation for BSGs? What is the gender predilection?

The peak age of BSG presentation is 5–9 yrs. Males are more commonly affected than females.

What are the 2 classes of BSGs? Where are they most commonly located, and what is the prognosis?

The 2 classes of BSGs are focal and diffuse.

1. 
   

   Focal (30%): in the upper midbrain/lower medulla; best prognosis

   
   
2. 
   

   Diffuse (70%): in the pons and upper medulla; infiltrative and worst prognosis

What BSG histology most commonly involves the medulla? The midbrain?

Glioblastoma multiforme in the medulla; grade 2 or 3 astrocytoma in the midbrain

Why does adult BSG tend to have a better prognosis?

Lesions in adults tend to be mostly low grade.

What is the median OS of BSG in adults vs. children vs. the elderly?

1. 
   

   Adults: 7.3 yrs

   
   
2. 
   

   Children: 1 yr

   
   
3. 
   

   The elderly: 11 mos

   
   
4. 
   

   Overall, the Dz is fatal in >90% of pts.

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