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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(04): e319-e324
DOI: 10.1055/s-0044-1795072
Review Article

Perspective on the Influence of Biopsy on the Survival of Pediatric Patients with Diffuse Brainstem Gliomas: A Literature Review

Perspectiva da influência da biópsia na sobrevida de pacientes pediátricos com Gliomas Difusos do Tronco: Uma revisão de literatura
Ádria Gabrielle Biondi-Soares
1   Department of Neurosurgery, Santa Casa de Misericórdia de Montes Claros, Montes Claros, MG, Brazil
,
Luís Gustavo Biondi-Soares
1   Department of Neurosurgery, Santa Casa de Misericórdia de Montes Claros, Montes Claros, MG, Brazil
,
Felipe Salvagni Pereira
2   Department of Neurosurgery, Hospital Angelina Caron, Curitiba, PR, Brazil
,
Willian Pegoraro Kus 
3   Department of Neurosurgery, Hospital Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
,
Ludimila Brito Batista
4   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
Cleiton Formentin
5   Department of Neurology, Universidade de Campinas, Campinas, SP, Brazil
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Abstract

Introduction Diffuse brainstem gliomas (DBG) represent the most common subtype of pediatric brainstem tumors, characterized by a systematically grim prognosis with a median survival rate of 10% two years post-diagnosis. Unlike other brain tumors, diffuse brainstem gliomas have traditionally relied on cranial magnetic resonance imaging (MRI) as a sufficient diagnostic tool, rendering surgical biopsies deemed unnecessary.

Objectives To conduct a literature review aiming to assess whether the performance of surgical biopsies has influenced the survival outcomes of children with diffuse brainstem gliomas.

Materials and Methods A comprehensive literature review was conducted using electronic databases PubMed, Embase, and LILACS. The search terms included “glioma” or “diffuse glioma” in conjunction with “pediatric” or “childhood,” combined with “biopsy” or “stereotactic,” and further combined with “brainstem,” “pons,” “pontine,” or “mesencephalon,” along with “survival.” The searches were limited to studies involving pediatric patients (age <18 years) published between 1980 and 2021.

Results The analysis of the presented data revealed morbidity ranging from 0% to 33.3% and mortality from 0% to 2.2%. Transfrontal access was predominantly favored by most authors, followed by transcerebellar approaches. The rate of inconclusive biopsies varied from 0% to 30%.

Conclusion Given the infiltrative nature of diffuse brainstem gliomas; surgical resection is generally deemed impractical. Radiation therapy remains the standard treatment, providing a marginal survival benefit of ∼3 months. There is currently no established chemotherapy protocol for this pathology.

Resumo

Introdução Gliomas difusos do tronco (GDT) são o subtipo de tumor de tronco pediátrico mais comum, com prognóstico sistematicamente sombrio e sobrevida média de 10%, após 2 anos do diagnóstico. Diferentemente dos outros tumores cerebrais, a ressonância magnética de crânio é considerada suficiente para diagnóstico dos gliomas de tronco, fazendo com que a biópsia seja desnecessária.

Objetivos Realizar uma revisão de literatura buscando verificar se a realização de biópsias cirúrgicas impactou de alguma forma na sobrevida das crianças com GDT.

Materiais e Métodos Revisão bibliográfica nas bases de pesquisa de dados eletrônicos PubMed, Embase e LILACS; a partir dos termos: “glioma” ou “glioma difuso,” em associação com “pediátrico” ou infância,” em combinação com “biópsia” ou “estereotática,” em combinação com “tronco cerebral,” ou “ponte,” ou “pontino,” ou “mesencéfalo” em combinação com “sobrevida.” As pesquisas foram limitadas a estudos em pacientes pediátricos (idade <18 anos), publicados entre 1980 2021.

Resultados Através da análise dos dados expostos foi possível observar que a morbidade variou de 0 a 33,3% e a mortalidade de 0 a 2,2%. A maioria dos autores preferiu a via de acesso transfrontal, seguida pela transcerebelar. A taxa de biópsias inconclusivas variou de 0 a 30%.

Conclusão Devido às características infiltrativas do tumor, a ressecção cirúrgica é desconsiderada. A radioterapia continua sendo o padrão de tratamento, conferindo benefício de sobrevida de cerca de 3 meses. Não há padrão de quimioterapia definido para essa patologia.

Keywords

brain stem neoplasms - gliomas - midline - diffuse - childhood - biopsy

Palavras-chaves

neoplasias do tronco encefálico - gliomas - linha média - difusos - infância - biópsia


Publication History

Received: 02 February 2024

Accepted: 18 October 2024

Article published online:
18 November 2024

© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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