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In contrast to childhood brainstem gliomas, adult brainstem gliomas are rare and poorly understood. The charts of 48 adults suffering from brainstem glioma were reviewed in order to determine prognostic factors, evaluate the effect of treatment and propose a classification of these tumours. Mean age at onset was 34 years range 16—70 years.
Patients and methods
Brainstem gliomas are not nearly as common in adults as they are in children. They are likely the final common consequence not of a single disease process but of several. They can be difficult to diagnose, and are challenging to treat. Clinical studies of this diagnosis are few and generally small. Because of these factors, our understanding of the biology of adult brainstem glioma is incomplete. However, the knowledge base is growing and progress is being made.
Lukas of Northwestern University Feinberg School of Medicine received honorariums from AbbVie and Novocure for speaking engagements, from Eisai for consulting work, and from Monetris as an advisory board member. This article includes discussion of brainstem gliomas in adults, diffuse midline glioma, diffuse midline glioma with histone mutation, H3 K27M mutant glioma, high-grade midline glioma with H3 K27M mutation, medullary glioma, midbrain glioma, pontine glioma, cystic brainstem glioma, diffuse brainstem glioma, exophytic brainstem glioma, and focal brainstem glioma. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations. In this article, the author discusses every aspect of brainstem gliomas, including pathology, molecular biology, clinical presentation, neuroimaging and diagnostic evaluation, differential diagnosis, prognosis and complications, surgical considerations, radiotherapy, and chemotherapy. In addition, a detailed list of references is included that contains over articles. Although the article focuses on adult patients, relevant information from the pediatric literature is also included. In this latest update, the author summarizes several new reports on the molecular biology of brainstem gliomas as well as new approaches to therapy. For more diffuse tumors, resection is impossible, and a biopsy is preferred.