The Surgical Resection of Brainstem Glioma: Outcomes and Prognostic Factors.
Adolescent
Adult
Astrocytoma
/ diagnostic imaging
Ataxia
/ physiopathology
Brain Stem Neoplasms
/ diagnostic imaging
Cerebrospinal Fluid Leak
/ epidemiology
Child
Child, Preschool
Diplopia
/ physiopathology
Ependymoma
/ diagnostic imaging
Female
Glioblastoma
/ diagnostic imaging
Glioma
/ diagnostic imaging
Headache
/ physiopathology
Humans
Hydrocephalus
/ epidemiology
Infant
Infant, Newborn
Kaplan-Meier Estimate
Karnofsky Performance Status
Machine Learning
Magnetic Resonance Imaging
Male
Middle Aged
Multivariate Analysis
Nausea
/ physiopathology
Neoplasm Grading
Neoplasm, Residual
Neurosurgical Procedures
Postoperative Complications
/ epidemiology
Prognosis
Retrospective Studies
Survival Rate
Tumor Burden
Vomiting
/ physiopathology
Young Adult
Brainstem glioma
Machine learning
Outcomes
Surgery
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
05
08
2020
revised:
27
10
2020
accepted:
27
10
2020
pubmed:
6
11
2020
medline:
3
7
2021
entrez:
5
11
2020
Statut:
ppublish
Résumé
The management of brainstem glioma remains controversial, with increasing evidence supporting surgical resection as the primary treatment for a select subgroup of tumors. However, there remains no consensus on the specific benefits and risks, the selection of surgical candidates, and prognostic factors that may further refine surgical indications. A retrospective single-surgeon chart review was performed for all patients who underwent surgical treatment for radiographically suspected brainstem glioma between 2000 and 2017. Preoperative and postoperative radiographic evaluations on magnetic resonance imaging were conducted. Survival outcomes were collected, and machine-learning techniques were used for multivariate analysis. Seventy-seven patients with surgical treatment of brainstem glioma were identified, with a median age of 9 years (range, 0-58 years). The cohort included 64% low-grade (I and II) and 36% high-grade (III and IV) tumors. For all patients, the 1-year and 5-year overall survival were 76.4% and 62.3%, respectively. Transient neurologic deficit was present in 34% of cases, and permanent deficit in a further 29%. The radical surgical resection of brainstem gliomas can be performed with acceptable risk in well-selected cases and likely confers survival advantage for what is otherwise a rapidly and universally fatal disease. Various radiographic features are useful during patient selection and may guide treatment selection.
Sections du résumé
BACKGROUND
The management of brainstem glioma remains controversial, with increasing evidence supporting surgical resection as the primary treatment for a select subgroup of tumors. However, there remains no consensus on the specific benefits and risks, the selection of surgical candidates, and prognostic factors that may further refine surgical indications.
METHODS
A retrospective single-surgeon chart review was performed for all patients who underwent surgical treatment for radiographically suspected brainstem glioma between 2000 and 2017. Preoperative and postoperative radiographic evaluations on magnetic resonance imaging were conducted. Survival outcomes were collected, and machine-learning techniques were used for multivariate analysis.
RESULTS
Seventy-seven patients with surgical treatment of brainstem glioma were identified, with a median age of 9 years (range, 0-58 years). The cohort included 64% low-grade (I and II) and 36% high-grade (III and IV) tumors. For all patients, the 1-year and 5-year overall survival were 76.4% and 62.3%, respectively. Transient neurologic deficit was present in 34% of cases, and permanent deficit in a further 29%.
CONCLUSIONS
The radical surgical resection of brainstem gliomas can be performed with acceptable risk in well-selected cases and likely confers survival advantage for what is otherwise a rapidly and universally fatal disease. Various radiographic features are useful during patient selection and may guide treatment selection.
Identifiants
pubmed: 33152495
pii: S1878-8750(20)32349-4
doi: 10.1016/j.wneu.2020.10.147
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e639-e650Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.