History of Management of Brainstem Gliomas in Children

Understanding of Disease

  • Identification of tumor subtypes: As imaging improved in the 1970s and 1980s, a broad spectrum of tumor types was found to occur in the brainstem. Modern imaging can distinguish the benign from the malignant tumor and the operable tumor from the inoperable one.

Technological Development

  • Imaging advances have improved management: Advances in the imaging of these tumors, specifically through the adoption of newer MRI modalities, has facilitated the diagnosis of, prognostic stratification of, and surgical planning for tumors of the brainstem (88-91).
  • Subtyping of tumors allows tailored treatment: Advances in the pathological diagnosis, genetic understanding, and different tumor subtypes may in the future permit tailored adjuvant therapy for previously incurable tumors (84-87).

Surgical Technique

  • IOM has increased the use of surgery: Advances in intraoperative neurophysiological monitoring and mapping allow for more tailored surgical approaches to resection in appropriate cases, thereby assisting in the preservation of corticobulbar motor tracts as well as cranial nerve nuclei (38).