Intracranial Hemorrhage from Pilocytic Astrocytoma in Pons

We report a case of brain-stem glioma with hemorrhage. A 24-year-old female presented with a 2-month history of headache, vomiting, right hemiparesis. Magnetic resonance image showed a 4X2.5cm sized mass with subacute stage hemorrhage in the left cerebellopontine angle. The mass and hemorrhage was surgically removed and pathological findings were consistent with pilocytic astrocytoma with recent hemorrhage. The patient discharged with mild neurological deficit.

A Case of Brain Stem Glioma Responded to Tamoxifen after Relapse with Chemotherapy and Radiotherapy / 대한소아혈액종양학회지

Tamoxifen is an oral triphenylethylene antiestrogen that has been used for breast cancer, but also inhibits protein kinase C(PKC) in a minority of malignant gliomas. Tamoxifen was administered orally in very high dose to a female brain stem glioma patient who had failed treatment with external beam hyperfractionated radiaton therapy and additional chemotherapy. Tumor reduction on MRI with clinical improvement occurred. Complications were mild thrombocytopenia, elevaton of transaminases and profuse production of hairs around both nipples and face. Although several patients with brain stem glioma had been treated with tamoxifen in our hospital, only one patient responded. Further study for the mechanism of tamoxifen activity to malignant glioma and patient characteristic evaluation will be required.

Brain Stem Gliomas in Adult: Correlation between MRI, Clinical Findings and Outcome: Preliminary Report

An analysis of 13 patients with brain stem glioma in adult, treated between 1988 and 1995, was undertaken. The purpose of this study is to establish the correlations between the MRI appearance, clinical findings and the prognosis. Based on the MRI appearance of the tumor at the time of clinical diagnosis, tumors were divided into four types: intrinsic diffuse, intrinsic focal, intrinsic cervicomedullary and exophytic type. Five patients were diagnosed pathologically by means of stereotactic biopsy(2 patients) and open surgery(3 patients), the rest were diagnosed on the basis of MRI appearance. All patients had received radiation therapy, and 11 patients had received chemotherapy during or immediately after radiation therapy. The methods of radiation therapy were either conventional or hyperfractionated type. The histological features were not always correlated with the prognosis. MRI and clinical findings could suggest the prognosis and probably the histological nature of the tumors. Moreover, response to initial radiotherapy and chemotherapy was considered to be a good prognostic factor. Seven of the 13 patients had response to the initial radiotherapy and chemotherapy. The poor prognostic factors determined in our study were 1) diffuse type 2) rapid growing with rim enhancement in spite of initial radiotherapy and chemotherapy 3) malignant pathologic finding 4) intratumoral necrosis after radiotherapy 5) multiple site involvement. The good prognostic factors were 1) intrinsic focal type 2) intrinsic cervicomedullary type 3) no cranial nerve involvement 4) good response to initial radiotherapy and chemotherapy.

Clinical Analysis of Brain Stem Glioma

The authors reviewed the cases of 25 patients, who were diagnosed as brain stem glioma by computerized tomography. The common presenting complains were the cranial nerve palsies, long tract signs and cerebellar dysfunction. Four distinct types of brain stem gliomas were identified based on CT scan characteristics: Type I included diffuse tumors; Type II included focal tumors; Type III included tumors involving cervicomedullary portion; Type IV(a) included exophytic tumors extending ventrally or laterally into the cerebellopontine or prepontine cistersns; Type IV(b) included exophytic tumors extending dorsally into fourth ventricle. The clinical presentation, efficacy of surgical intervention, pathology, and prognosis of those tumors were correlated within these typing. The prognosis was poorer in children who presented with multiple cranial nerve palsies, and such children were more likely to have malignant astrocytoma. Type I(diffuse tumors) had the poorest prognosis and less response to radiation while Type II(focal tumors) had relatively good response to radiation. Through surgery and post operative radiotherapy, survival times were significantly longer in patients with Type III(cervicomedullary tumor) which was more likely to be low grade astrocytoma. The prognosis of patients with Type IV-b(4th ventricle tumor) was variable but better than those with Type IV-a(prepontine tumors) or Type I(diffuse tumors). Patient with tumor biopsies that were histologically benign survived significantly longer than those whose tumors were malignant. It is concluded that patient with Type III cervicomedullary tumors or Type IV exophytic tumor may be improved through surgery and postoperative radiotherapy, and radiotherapy is useful method in treatment of patients with Type I diffuse tumors or Type II focal tumors.

A BRW Stereotaxic Biopsy of Brain Stem Glioma / 영남의대학술지

Histopathological diagnosis of brain stem glioma should be performed for the purpose of the determination of its management and clinical course, but its surgical biopsy has been followed by high mortality and morbidity. We performed the tissue sampling for histological examination with BRW stereotaxic system under local anesthesia successfully.