Stereotactic management of cystic gliomas of the brain stem

Although cystic gliomas of the brain stem can be readily aspirated using a stereotactic technique, they will frequently recur, resulting in progressive neurological deficit. Since standard neurosurgical approaches to cystic gliomas of the cerebral hemispheres and cerebellum are difficult to apply to brain stem lesions, modification of these techniques are necessary to provide cyst control with minimal morbidity and mortality. This report, based upon 12 procedures performed on 10 patients with gliomas of the mesencephalon, pons, and medulla, details an approach using aspiration, stereotactically placed cyst catheters, and/or intracavitary irradiation with colloidal chromium phosphorus-32 in addition to external radiation therapy and chemotherapy. Cyst control without mortality or permanent morbidity was obtained in all patients using this multimodality approach.