Brain stem gliomas of children. A clinicopathological study

To determine the risks and benefits of biopsying brain stem gliomas of children, the authors analyzed the clinical and histopathological features of 27 children with biopsied brain stem gliomas and compared them to 26 children with brain stem gliomas that were not biopsied. In both groups, cranial nerve palsies at the time of diagnosis were associated with increased mortality. There was no operative mortality and low operative morbidity associated with biopsies, and 35% of the biopsied children survived 5 years or longer. Children with exophytic tumors and those who received more than 4000 rad survived significantly longer. When the histologic features of pleomorphism, nuclear hyperchromatism, and mitoses were present, they occurred uniformly throughout each biopsy, regardless of the sample size. Mitoses in the biopsy specimen were associated with significantly increased mortality. The authors conclude that the risk of biopsying brain stem gliomas in children is low, and that the benefit is the identification of those children who should be treated more intensively because of their poor prognosis.