FEATURES OF BRAIN STEM TUMORS IN CHILDREN

Brain stem tumors account for about 10-20% of childhood brain tumors. Peak incidence for these tumors occurs around age 6 to 7 years. Aim: Despite their severity and poor prognosis, brain stem tumors remain an area of intense research with regard to their diagnosis and management. Material and methods: In the interval 2003-2010, 8 children (4 girls and 4 boys) aged 2-13 years (mean age 6.82), diagnosed with brain stem tumors were followed up. Disease history, onset symptoms, complete physical, laboratory and imaging investigations, and individualized therapeutic approach have been reviewed. Family history was considered to be of particular clinical importance. Monitoring the disease progression was possible until the time of death (when it occurred in hospital) or by information provided by the family and family physician in cases where death occurred at patient's home. Results: Clinical signs and symptoms depend on tumor location, its aggressiveness, and patient's age. Progressive neurological deficits, signs and symptoms caused by increased intracranial pressure, visual disturbances, behavioral disorders, seizures, endocrine disruption, failure to thrive may occur in various combinations. In only 50% of our cases the tumor could be removed. Imaging proved highly suggestive for a brain stem tumor. Histopathological examination diagnosed one pilocytic astrocytoma (grade I), one fibrillary astrocytoma (grade II), one anaplastic astrocytoma (grade III), and one glioblastoma multiforme (grade IV). In the remaining 4 cases imaging was suggestive for glial tumors. Multimodal therapy was used in 2 patients, 7 received adjuvant chemotherapy, and in 1 case no therapy was administered because the tumor rapidly progressed to death. Seven of our patients died on an average of 6.28 months after the diagnosis (range 2 to 9 months). A family history of brain tumors in 2 of our cases supports the hypothesis of genetic factors involvement. Conclusions: Brain stem tumors are still difficult to investigate, and the results on their long- and medium-term survival remain uncertain.