| Clinical observation on brainstem glioma in childhood. |
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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 |
| 소아기 뇌간신경교종 (Brainstem Glioma) 에 대한 임상적 고찰 |
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조현전1, 황세희1, 황용승1, 김인원2 |
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 방사선과학교실 |
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Received: 25 September 1990 • Accepted: 29 November 1990 |
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| Abstract |
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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) |
| Key Words:
Brainstem glioma |
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