[Surgical treatment of brainstem gliomas and other tumors in adults].

BACKGROUND AND PURPOSE

After the introduction of MR imaging to the diagnostics of brainstem tumors and after the introduction of microsurgical procedures to their treatment, the successful treatment, particularly of focal and exophytic forms of these tumors has begun all over the world. The objective of this paper is to establish indications for surgical treatment of gliomas and other tumors of brainstem, to determine surgical approaches and to establish the outcome.

MATERIAL AND METHODS

Within the last 6 years, 12 patients with focal and exophytic tumors of the brainstem in adults were operated on. 5 tumors were located in the midbrain, 4 in the pons, 2 in the medulla oblongata and 1 was a cervicomedullary one. With one exception, all tumors were approached via the posterior fossa.

RESULTS

The total removal was performed in 75% and a subtotal one in 25% of cases. A serious complication in 2 patients was bilateral ptosis after the removal of midbrain tumors. This lesion gradually regressed. A similar dangerous complication is impaired swallowing and coughing reflex loss which, by exposing the patient to the risk of aspiration pneumonia, occurred in 2 patients. One of these patients died after the operation.

CONCLUSIONS

Patients with focal and exophytic forms of the brainstem tumors in MR imaging are qualified for surgical treatment. Immediate results of the treatment depend on the localization and size of the neoplasm. A precise operative approach, use of the neurophysiological examination and postoperative care at the Intensive Care Unit are essential conditions to obtain good results of the operative treatment.