Brainstem glioma

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Obesity, Sleep & Internal medicine
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Brainstem glioma
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Headache, nausea, vomiting, ataxia, dysphagia, dysarthria, cranial nerve palsies
Complications	Hydrocephalus, brainstem compression
Onset	Typically in childhood
Duration	Variable
Types	Diffuse intrinsic pontine glioma, focal glioma, exophytic glioma
Causes	Unknown
Risks	Genetic predisposition, radiation exposure
Diagnosis	MRI, biopsy
Differential diagnosis	Brainstem stroke, multiple sclerosis, encephalitis
Prevention	N/A
Treatment	Radiation therapy, chemotherapy, surgery
Medication	N/A
Prognosis	Generally poor for diffuse types, better for focal types
Frequency	Rare, accounts for 10-20% of all pediatric brain tumors
Deaths	N/A

Brainstem Glioma

Classification of brainstem gliomas by MRI appearance

A brainstem glioma is a type of brain tumor located in the brainstem, which is the posterior part of the brain adjoining and structurally continuous with the spinal cord. These tumors are most commonly found in children and can vary significantly in terms of their histology and prognosis.

Anatomy and Function of the Brainstem

The brainstem is a critical structure in the central nervous system that connects the cerebrum with the spinal cord. It is responsible for regulating many vital functions, including breathing, heart rate, and blood pressure. The brainstem is divided into three main parts: the midbrain, pons, and medulla oblongata.

Types of Brainstem Gliomas

Brainstem gliomas can be classified based on their location, growth pattern, and histological characteristics. The most common type is the diffuse intrinsic pontine glioma (DIPG), which primarily affects the pons. Other types include focal gliomas, which are more localized and have a better prognosis.

Diffuse Intrinsic Pontine Glioma (DIPG)

Histologic geographic variability of diffuse intrinsic pontine glioma (DIPG)

DIPG is a highly aggressive and difficult-to-treat tumor that arises in the pons. It is characterized by its diffuse growth pattern, which makes surgical resection impossible. DIPG primarily affects children, with the peak incidence occurring between the ages of 5 and 10 years.

Symptoms

The symptoms of brainstem gliomas depend on the tumor's location and size. Common symptoms include:

• Cranial nerve deficits, such as facial weakness or double vision
• Ataxia or difficulty with coordination
• Headache and nausea due to increased intracranial pressure
• Dysphagia or difficulty swallowing

Diagnosis

Diagnosis of brainstem gliomas typically involves magnetic resonance imaging (MRI), which provides detailed images of the brain and can help in assessing the tumor's extent and characteristics. Biopsy is rarely performed due to the risks associated with the procedure in this sensitive area.

Treatment

Treatment options for brainstem gliomas are limited and primarily focus on palliative care to relieve symptoms. Radiation therapy is the mainstay of treatment for DIPG, although it is not curative. Chemotherapy has shown limited effectiveness, and research is ongoing to find more effective treatments.

Prognosis

The prognosis for patients with brainstem gliomas varies depending on the type and location of the tumor. DIPG has a particularly poor prognosis, with a median survival of less than one year after diagnosis. Focal gliomas, on the other hand, may have a more favorable outcome.

Research

Ongoing research is focused on understanding the molecular biology of brainstem gliomas and developing targeted therapies. Clinical trials are exploring new chemotherapeutic agents, immunotherapy, and gene therapy approaches.

See also

• Glioma
• Central nervous system tumor
• Pediatric oncology

Brainstem glioma