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Focal brainstem glioma

Last revised by Dr Yair Glick on 19 Feb 2018

Focal brainstem gliomas are a relatively uncommon type of brainstem glioma, which carry a more favorable prognosis compared to the more common diffuse brainstem glioma. The name is a reflection of the imaging findings, which demonstrate a sharply demarcated mass with relatively frequent enhancement on MRI.

Pathology

The majority are low grade (60%) with most tumors being pilocytic astrocytomasGangliogliomas and oligodendrogliomas also occasionally found. Higher grade tumors (40%) are usually fibrillary astrocytoma or GBM

Histology

The histology of focal brainstem gliomas is variable and may be both of low-grade (accounting for the much better prognosis) or high-grade.

Radiographic features

Distinguishing between high-grade and low-grade focal brainstem gliomas is clearly important but difficult, and biopsy potentially carries severe morbidity. Diffusion tensor imaging (DTI) and tractography can help by delineating relationship of tracts with respect to the mass. If tract invasion is demonstrated, this suggests a more infiltrating (thus higher grade and poorer prognosis) histology.

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Cases and figures

  • Case 1: midbrain glioma
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  • Case 2
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