The Relationship Between Location and Prognosis in Brain-Stem Tumors

The objective of this study was to establish a correlation between histopathology and radiological characteristics as well as location of brain stem tumors. Results of therapy were also analysed in relation to the radiological characteristics. Forty four patients were evaluated from a clinical and neuroradiological viewpoint (CT and MRI). In 14 of them we ruled out a surgical therapy. However 30 patients with an age ranging from 4 to 62 years were operated on with complete resection in most cases. We attempted to correlate histopathology with the radiological pattern and location of the tumours. The clinical presentation was as follows: symptoms of cranial nerve involvement in 21, cerebellar symptoms in 18 and pyramidal syndrome in 13. Histopathology was obtained by means of stereotactic biopsy in 4 cases and by means of surgical specimens in 26 cases. Tumors were well defined (focal) in 16 cases and diffuse in 14. Complete removal was achieved in 18 cases and partial in 8. Intraoperative neurophysiologic monitoring was carried out in all cases. Most malignant tumors tend to locate in the pons and to be radiologically diffuse. Conversely, benign tumors use to be focal and to locate in the midbrain, medulla and cervicomedullary junction. There is a good correlation between histopathology and the anatomical location of brain-stem tumors. An adequate selection of cases for surgery based on clinicoradiological criteria and the use of intraoperative neurophysiologic monitoring are of help to improve prognosis after surgery in brain stem tumors.