Abstract
BRAINSTEM GLIOMAS DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG)

*Dr. Madleen Jawad Sobhe Abu Aser, Dr. Amjad Alanqar and Professor Abdalkarim Radwan

ABSTRACT

Brain stem glioma is a very rare case. The incidence of this case is not known. Brainstem gliomas of diffuse intrinsic pontine glioma remain poorly understood and the dismal prognosis has not changed despite various attempts to add chemotherapy to standard radiation. High –grade gliomas are malignant, often rapidly progressive brain tumors that divided into anaplastic astrocytoma, anaplastic oligodendroglioma, and glioblastoma based upon their histopathologic and molecular features. Brainstem gliomas have been one of the most difficult pediatric cancers to treat. Tumors arising in the brainstem were once uniformly discounted as surgically resectable lesions. Early neurosurgeons thought this location to be inoperable and fraught with disaster. The advent of computed tomography (CT), magnetic resonance imaging (MRI) and sophisticated neurophysiologic monitoring techniques have significantly advanced the surgical treatment of these lesions. Gliomas within the brainstem comprise 10-20% of all pediatric CNS tumors. Brainstem gliomas can occur at any age, although they generally present in childhood, with the mean age of diagnosis at 7 to 9 years. There is no gender predilection. The brainstem consists of three parts: the midbrain, the pons, and the medulla oblongata. DIPG is a pontine glioma, meaning that it develops in the pons. Diffuse Intrinsic Pontine Glioma, commonly referred to as pontine glioma, infiltrative brainstem glioma, or DIPG, is a rare tumor of the brainstem that occurs almost exclusively in children. A pontine glioma occurs in the most delicate area of the brainstem, which controls many critical functions, including breathing and blood pressure. Its location, as well as the way it infiltrates normal brain tissue, makes it especially difficult to treat. There are about 300-350 new cases of DIPG diagnosed each year in the United States, usually in children under the age of 10. DIPG affects boys and girls equally. Brainstem gliomas are now recognized as a heterogeneous group of tumors. The classification systems provide a framework to predict growth patterns, surgical resectability and overall prognosis for these heterogeneous tumors. These systems allow the surgeon to better differentiate low-grade tumors from the diffuse inoperable tumor type. The WHO classification scheme of brain tumors remains the primary basis for guiding therapy and assessing overall prognosis in patients with a brain tumor. In this case study, we are going to discuss a 2 years old female child who was diagnosed with pontine glioma which is very aggressive and can cause death. Brain stem gliomas are present in 20% all-in neoplasm. MRI and all diagnostic reports show the diffuse intrinsic pontine gliomas. Surgical treatment reveals with no outcomes. The patient is on conservative management. The patient is improving health but the treatment is under process.

Keywords: computed tomography (CT), magnetic resonance imaging (MRI).


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