The Surgical Resection of Brainstem Glioma: Outcomes and Prognostic Factors.

Abstract Object The management of brainstem glioma remains controversial, with increasing evidence supporting surgical resection as the primary treatment for a select subgroup of tumours. However, there remains no consensus on the specific benefits and risks, the selection of surgical candidates, and prognostic factors that may further refine surgical indications. Methods A retrospective, single-surgeon, chart review was performed for all patients who underwent surgical treatment for radiographically suspected brainstem glioma between 2000 and 2017. Pre-operative and post-operative radiographic evaluations on MRI were conducted. Survival outcomes were collected, and machine learning techniques were used for multivariate analysis. Results 77 patients with surgical treatment of brainstem glioma were identified, with a median age of 9 (range 0 – 58). The cohort included 64% low-grade (I and II) and 36% high-grade (III and IV) tumours. For all patients, the 1- and 5-year overall survival rates were 76.4% and 62.3%, respectively. Transient neurological deficit was present in 34% of cases, and permanent deficit in a further 29%. Conclusion The radical surgical resection of brainstem gliomas can be performed with acceptable risk in well-selected cases and likely confers survival advantage for what is otherwise a rapidly and universally fatal disease. Various radiographic features are useful during patient selection and may guide treatment selection.