Childhood brainstem gliomas: A non-aggressive management

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. Our study aims to suggest a consensus for non-aggressive management for Pediatric brainstem gliomas. This is a retrospective study at the Neurosurgery department of l’Hôpital Des Spécialités Rabat. All children with Brainstem glioma managed from January 2008 to April 2020. 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 astrocytoma (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. 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.