Aspiration prevention surgeries for adult patients with brainstem malignant gliomas: illustrative cases

BACKGROUND Adult patients with brainstem gliomas have a poor prognosis, with a median survival of approximately 1 year. Although patients often remain conscious until the end of life, lesions affecting the medulla oblongata can cause severe dysphagia and increase the risk of aspiration and suffocation. These symptoms significantly reduce quality of life (QOL) during advanced stages. While aspiration prevention surgery is often performed for severe dysphagia in other conditions, its efficacy in adult patients with brainstem gliomas remains unclear. OBSERVATIONS This report presents 2 cases of adult patients with malignant brainstem gliomas who develoved progressive dysphagia. In case 1, glottic closure was performed as an aspiration prevention surgery; however, postoperative complications delayed the resumption of oral feeding, and the patient died due to tumor progression. In case 2, total laryngectomy was performed as an aspiration prevention surgery, which facilitated long-term oral intake and resulted in a good functional outcome, despite subsequent disease progression. LESSONS Aspiration prevention surgery may benefit selected adult patients with malignant brainstem gliomas. However, potential complications must be carefully considered. Further studies with larger sample sizes are needed to assess the impact of this intervention on QOL and clinical outcomes. https://thejns.org/doi/10.3171/CASE25284