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Exophytic glioma of the medulla: presentation, management and outcome
Mohammad Ghodsi1, Abolghasem Mortazavi, Shima Shahjouei
1Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
Insights
Exophytic gliomas of the medulla are rare pediatric tumors, primarily pilocytic astrocytomas. Complete surgical removal is recommended, with electrophysiological monitoring aiding in preserving neural tissue and minimizing complications.
Area of Science:
- Pediatric neuro-oncology
- Neurosurgery
- Childhood brain tumors
Background:
- Exophytic gliomas of the medulla are rare childhood tumors.
- Pilocytic astrocytomas are the most common type.
Purpose of the Study:
- To report the experience with 11 children diagnosed with exophytic gliomas of the medulla.
- To review clinical, radiological, and follow-up data.
Main Methods:
- Retrospective study of pediatric patients (2002-2013).
- Review of clinical, radiological, and follow-up records.
- Analysis of patient demographics and treatment outcomes.
Main Results:
- Most patients were male, aged 11 months to 7 years.
- Common symptoms included swallowing problems, failure to thrive, nausea, and vomiting.
- Gross total resection was achieved in 8 patients; most tumors were pilocytic astrocytomas. One recurrence was noted in a fibrillary astrocytoma.
Conclusions:
- Gross total resection of symptomatic dorsal exophytic medullary glioma is recommended.
- Electrophysiological monitoring is crucial for preserving neural tissue during surgery.
- Regular follow-up with clinical examination and MRI is mandatory; adjuvant therapies are considered for recurrence or progression.
Objective:
Exophytic gliomas of the medulla are rare childhood tumors that mostly are pilocytic astrocytomas. Here we report our experience in 11 -children with this rare tumor.
Methods:
A retrospective study was performed using the records of children with exophytic gliomas of the medulla at Children's Hospital Medical Center in Tehran, Iran, from 2002 through 2013. The general, clinical, and radiological data and follow-up of all patients were reviewed.
Results:
The patients mostly were male aged from 11 months to 7 years. Swallowing problems, failure to thrive and nausea and vomiting were the most common symptoms. The time span between the onset of symptoms and the diagnosis was 2-24 months. Gross total resection of tumor was possible in 8 patients. Most tumors were pilocytic astrocytomas. Patients were followed for 2 months to 11 years (mean = 3.6 years). There was no intraoperative mortality. Recurrence occurred in 1 child with fibrillary astrocytoma.
Conclusion:
Gross total resection of symptomatic dorsal exophytic medullary glioma is recommended. Most tumors are pilocytic astrocytomas. The attachment of these tumors to important brainstem structures usually inhibits total resection. Electrophysiological monitoring of sensorimotor pathways and cranial nerves can be helpful to preserve surrounding neural tissue during tumor resection and to minimize complications. Regular follow-up of patients with clinical examination and brain MRI is mandatory. Repeated surgery, radiation therapy and chemotherapy are suggested in cases with tumor recurrence or progression.
