Childhood brainstem gliomas: A non agressive management

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Résumé

Backgrounds: Childhood primary brain tumors, including brainstem gliomas, are a diverse group of conditions
that constitute the most common solid tumor in the pediatric population with many management challenges in
LMICs.
Objective: Our study aims to suggest a consensus for non-aggressive management for Pediatric brainstem gliomas.
Methods: This is a retrospective study at the Neurosurgery department of l’Hˆopital Des Sp´ecialit´es Rabat. All
children with Brainstem glioma managed from January 2008 to April 2020.
Results: Seventeen patients with Brainstem glioma were managed during the study period and were included in
this analysis. Patients were 7.1 years old (median) [IQR: 1.3–17] at diagnosis, and 65% were boys. Diffuse
intrinsic pontine glioma Type I was strongly retained on MRI in eight cases (47%) versus 9 cases (53%) of FBSG
in our cases. Multidisciplinary joint concertation between pediatric neuro-oncologists and neurosurgeons was
done for therapeutic decision-making. Stereotaxic biopsy (STB) with Leksell frame was performed in five cases of
FBSG (29.41%) to have pathology, and four patients of FBSG (23.52%) had a focal resection with high extent
resection >90%. We sent the 8 cases of DIPG to the neuro-oncology department for management. Three (37,5%)
of them benefited from CSF shunt before. Histo-pathology with Immunohistochemistry revealed pilocytic as-
trocytoma (33%; n= 03), gangliogliomas infiltrating the brainstem (23%; n= 02), anaplastic astrocytoma (33%;
n=03) and oligodendroglioma Grade III of WHO (11%; n=1).One case (20%) of focal hematoma occurred after
Stereotaxic biopsy without clinical worsening. For DIPG, the median survival time was nine months (IQR: 5-16),
whereas the median survival time was 28,5 months(IQR: 13 to 65,3) in FBSG cases.
Conclusion: In the case of brainstem glioma, we suggest not harming the child’s brainstem by performing safe
focal resection or STB on FBSG and referring DIPG patients to neuro-oncology for management.

Mots-clés

Childhood Diffuse pontine glioma Focal brainstem glioma