Brain stem gliomas in children

A retrospective analysis of children with brain stem glioma was made to determine whether computed tomography (CT) appearances could be correlated with histopathological features and survival times. Based on initial CT appearances of brain stem gliomas, the tumors were classified into two types: diffuse and localized. A diffuse tumor is a large hypodense mass with or without contrasted enhancement (CE) lesions, and a localized tumor is a well circumscribed mass without associated edema. Among 30 cases diagnosed by CT, 25 had diffuse and 5 had localized tumors. All of the patients with diffuse tumors died within 23 months (mean: 10.3 months) after admission, whereas the patients with localized tumors have lived more than 24 months (mean: 66.7 months). Histopathological diagnoses were available for 39 patients, and 22 of those were also diagnosed by CT. The majority of the patients with diffuse tumors (17/18) had high grade glioma (grade III or IV astrocytoma), and all of the patients with localized tumors (4/4) had low grade gliomas (grade I or II astrocytomas). The median survival time of the patients with high grade of gliomas (n=31) was 8.4 months and that of the patients with low grade gliomas (n=8) was 56.5 months. The difference is significant (P<0.05, the generalized Wilcoxon test). The results of this study suggest that the CT appearances of pediatric brain stem gliomas may predict their histopathological features and assess the prognosis. (author)