RADIOLOGY OF BRAINSTEM GLIOMA

How Not to Miss a Pediatric Brain Tumor by Prof Shlomi Constantini. Brain tumors are the most common solid tumors in children - how to identify signs and symptoms?

Pediatric Glioma and Brainstem Gliomas are complex entities which are not so commonly discussed. Although not so uncommon, peditric gliomas are difficult to treat because of many reasons. Dr Ahitagni Biswas, who is working as an Associate Professor at All India Institute of Medical Sciences, New Delhi, has discussed these two difficult topics nicely with contemporary guidelines and evidences.

Pediatric Brain Cancer

David S. Hersh, MD,1,2 Katherine N. Sanford, BS,1 Kenneth Moore, MD,1 and Frederick A. Boop, MD1–3

1Department of Neurosurgery, University of Tennessee Health Science Center; 2Le Bonheur Children’s Hospital; and 3Semmes Murphey Clinic, Memphis, Tennessee

Dorsally exophytic brainstem tumors arise from within the brainstem itself. As the tumor grows, it pulls eloquent tissue with it, resulting in a shape that is analogous to the sides of a volcano. Rather than a resection that is flush with the brainstem being performed, this functional tissue on the lateral edges of the tumor must be identified and preserved in order to avoid postoperative deficits. The authors describe a midline, suboccipital approach with the use of intraoperative direct stimulation to identify and preserve functional tissue innervating the palate during the resection of a dorsally exophytic medullary tumor.


**Intro music: "Daybreak" by Graeme Rosner

James K. Liu, MD, and Vincent N. Dodson, BS

Department of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, RWJ Barnabas Health, Newark, New Jersey

Cervicomedullary gangliogliomas are rare low-grade neoplasms of the brainstem. They can be challenging lesions to resect due to the eloquent location in the brainstem. In some instances, the absence of a clear surgical plane between the tumor and normal neural tissue can prohibit a complete resection. Therefore, it is important to leave a thin rim of residual tumor at the tumor-brainstem interface in order to avoid irreversible neurological injury. In this operative video, the authors demonstrate the technique to develop a surgical pseudoplane using sharp microdissection for a cervicomedullary brainstem ganglioglioma without a clear interface between the tumor and normal neural tissue. This strategy allowed for radical near-total resection of the tumor, thereby maximizing the extent of removal while preserving neurological function. Postoperatively, the patient had normal neurological function and returned to work without any disability. In summary, due to the lack of a clear surgical dissection plane, a pseudoplane near the surgical interface can be performed using sharp dissection to facilitate radical near-total resection.



**Intro music: "Daybreak" by Graeme Rosner

Manas Panigrahi