Surgical Approaches to Medullary Tumors

This chapter provides an overview of medullary gliomas based on a retrospective study of 43 consecutive patients who underwent microsurgical tumor removal between 1996 and 2019. These tumors form a subgroup of intrinsic brainstem gliomas. The authors have analyzed the clinical and morphological features, patient selection, management strategies, surgical aspects, tumor pathology, and outcome in this series of bulbar gliomas. Since the indication for surgery is not generally accepted in the literature, proper patient selection was highly individualized, based on the senior author’s personal experience with microsurgical resection of various intrinsic brainstem lesions. Not only exophytic but also purely intrinsic low-grade gliomas were the best candidates for surgery. Moreover, even extensive cervicomedullary tumors could be resected totally or subtotally with excellent clinical results. In patients with high-grade tumors, the surgery provided a benefit that exceeded good palliative care. The authors conclude that in carefully selected patients, surgery may play an important role in the overall management of bulbar gliomas. Furthermore, the authors recommend not considering gliomas of the medulla synonymous with inoperable lesions but attempting to identify bulbar glioma patients who may profit from surgical treatment, similar to the cases shown in the present chapter.