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Surgical excision of brainstem spongioblastoma in two pediatric patients resulted in significant neurological recovery. This microsurgical approach via the fourth ventricle floor proved effective for benign, circumscribed tumors.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Neuroncology
Background:
- Spongioblastomas, particularly those with brainstem involvement, present significant surgical challenges.
- Microsurgical techniques offer potential for precise tumor resection in eloquent brain areas.
- Pediatric brainstem tumors require tailored treatment strategies considering long-term outcomes.
Observation:
- Two pediatric patients (ages 5 and 14) with circumscribed spongioblastoma extending into the pons and midbrain were treated.
- The tumors exhibited characteristics suggestive of benignancy: long clinical history, well-defined margins with cystic components on CT, and localized fourth ventricle floor protrusion on ventriculography.
- Preoperative neurological deficits included severe hemiparesis and cranial nerve palsies (VI and VII).
Findings:
- Successful microsurgical excision of the spongioblastoma was achieved via the floor of the fourth ventricle.
- Patients demonstrated slow but continuous improvement in neurological deficits post-surgery.
- The functional neurological status achieved was satisfying when compared to the preoperative condition.
Implications:
- Microsurgical resection through the fourth ventricle floor is a viable and effective treatment for selected benign spongioblastomas with intrapontine-intramesencephalic extension in children.
- Early surgical intervention in pediatric brainstem tumors, when benign features are present, can lead to favorable neurological recovery.
- This approach highlights the importance of detailed preoperative imaging and clinical history in guiding surgical strategy for pediatric brainstem tumors.
Abstract:
Excision of a circumscribed spongioblastoma with intrapontine-intramesencephalic extension was performed via the floor of the fourth ventricle in two girls 14 and 5 years of age. The preoperative neurological deficits (severe hemiparesis, cerebellar, and sixth and seventh cranial nerve disturbances) showed slow but continuous improvement to a satisfying neurological condition, if compared with the preoperative state. The indication for this microsurgical procedure is supported by findings, that indicate the tumour to be benign: (1) a long history, (2) a well circumscribed tumour including a cyst, as seen on CT, and (3) a localized protrusion of the floor of the fourth ventricle on ventriculography.