Skip to main content

Advertisement

Log in

Pediatric brain stem lesions: introduction of a scoring system for clinical evaluation and their treatment analysis

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Brainstem lesions in pediatric age group include mainly gliomas. As these are not usually amenable to complete surgical resection, multimodality treatments are used. To assess treatment responses, Karnofsky’s Performance Score (KPS) has been the gold standard; however, in pediatric patients, comprehensive neurological examination is more valuable.

Objective

Our purpose was to formulate neurological examination based scoring system and compare its effectiveness with KPS.

Materials and methods

A retrospective analysis of 37 pediatric patients with brainstem lesions was performed. All these patients were assessed both pre- and post-treatment and in every follow up using standard KPS and our proposed scoring system, Kumar’s and Samir’s Score (K&SS). K&SS was devised choosing the common clinical features and those affecting outcome the most. Twenty-two features were hence selected, and points were allotted to each according to their functional importance, with range from 22 to 100.

Results and discussion

Twenty-seven had gliomas, and in nonglioma group, seven had brainstem tuberculosis (BSTB). Nineteen patients with BSG were less than 6 years of age. Most gliomas were pilocytic astrocytomas (n = 21). Outcome analysis of patients in both groups using KPS showed deterioration or no change in the scores in majority whereas using K&SS, most patients showed improvement.

Conclusion

Gliomas form majority of pediatric brainstem lesions, with high occurrence of BSTB in nongliomatous group. Our proposed scoring system, based on comprehensive neurological examination, is more sensitive than KPS in treatment analysis of brainstem lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Albright AL, Guthkelch AN, Packer RJ, Price RA, Rourke LB (1986) Prognostic factors in pediatric brain-stem gliomas. J Neurosurg 65(6):751–755

    PubMed  CAS  Google Scholar 

  2. Benesch M, Lackner H, Moser A, Kerbl R, Schwinger W, Oberbauer R et al (2001) Outcome and long term side effects after synchronous radio chemotherapy for childhood brainstem gliomas. Pediatr Neurosurg 35:173–180

    Article  PubMed  CAS  Google Scholar 

  3. Epstein F, Constantini S (1996) Practical decisions in the treatment of pediatric brainstem tumours. Pediatr Neurosurg 24:24–34

    PubMed  CAS  Google Scholar 

  4. Epstein F, McCleary FI (1986) Intrinsic brainstem tumours of childhood: surgical indications. J Neurosurg 64:11–15

    PubMed  CAS  Google Scholar 

  5. Fisher PG, Breiter SN, Carson BS, Wharam MD, Williams JA, Weingart JD et al (2000) A clinicopathological reappraisal of brainstem tumor classification. Cancer 89(7):1569–1576

    Article  PubMed  CAS  Google Scholar 

  6. Freeman CR, Farmer JP (1998) Pediatric brainstem gliomas: a review. Int J Radiation Biol Phys 40(2):265–271

    CAS  Google Scholar 

  7. Galanis E, Buckner JC, Novotny P, Morton RF, McGinnis WL, Dinapoli R, Schomberg P, O’Fallon JR (2000) Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas. J Neurosurg 93(2):201–207

    PubMed  CAS  Google Scholar 

  8. Gilbert M, Armstrong T, Meyers C (2000) Issues in assessing and interpreting quality of life in patients with malignant glioma. Semin Oncol 27(3 Suppl 6):20–26

    PubMed  CAS  Google Scholar 

  9. Hoffman HJ (1997) Brainstem gliomas. Clin Neurosurg 44:549–558 (review)

    PubMed  CAS  Google Scholar 

  10. Kumar R, Jain R, Kaur A, Chhabra DK (2000) Brainstem tuberculosis in children. Br J Neurosurg 14(4):356–361

    Article  PubMed  CAS  Google Scholar 

  11. Kun LE, Mulhern RK, Crisco JJ (1983) Quality of life in children treated for brain tumours. J Neurosurg 58:1–6

    Article  PubMed  CAS  Google Scholar 

  12. Lassiter KRL, Alexender E Jr, Davis CH Jr, Kelley DL Jr (1971) Surgical treatment of brainstem gliomas. J Neurosurg 4:719–725

    Google Scholar 

  13. Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, Lillehei KO, Bernstein M, Brem H, Sloan A, Berger MS, Chang S (2003) Glioma outcomes investigators: Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the glioma outcomes project. J Neurosurg 99(3):467–473

    PubMed  Google Scholar 

  14. Lesniak SM, Klem JM, Weingart J, Carson BA (2003) Surgical outcome following resection of contrast enhanced pediatric brainstem gliomas. Pediatr Neurosurg 39:314–322

    Article  PubMed  Google Scholar 

  15. Maria BL, Rehder K, Eskin TA, Hamed LM, Fennell EB, Quisling RG, Mickle JP, Marcus RB Jr, Drane WE, Mendenhall NP et al (1993) Brainstem glioma: pathology, clinical features, and therapy. J Child Neurol 8(2):112–128 (review)

    PubMed  CAS  Google Scholar 

  16. Milstein JM, Cohen ME, Sinks LF (1985) The influence and reliability of neurological assessment and Karnofsky performance score on prognosis. Cancer 56(7):1834–1836

    Article  PubMed  CAS  Google Scholar 

  17. Mulhern RK, Heideman RL, Khatib ZA, Kovnar EH, Sanford RA, Kun LE (1994) Quality of survival among children treated for brain stem glioma. Pediatr Neurosurg 20(4):226–232

    PubMed  CAS  Google Scholar 

  18. Packer RJ, Nicholson HS, Johnson DL, Vezina LG (1992) Dilemmas in the management of childhood brain tumours: Brainstem gliomas. Pediatr Neurosurg 17:1404–1413

    Google Scholar 

  19. Panitch HS, Berg BO (1970) Brainstem tumors of childhood and adolescence. Am J Dis Child 119:465–472

    PubMed  CAS  Google Scholar 

  20. Packer RJ, Boyett JM, Zimmerman RA, Albright AL, Kaplan AM, Rorke LB, Selch MT, Cherlow JM, Finlay JL, Wara WM (1994) Outcome of children with brain stem gliomas after treatment with 7800 cGy of hyperfractionated radiotherapy. A Children’s Cancer Group Phase I/II Trial. Cancer 74(6):1827–1834

    Article  PubMed  CAS  Google Scholar 

  21. Pollack IF (1994) Brain tumors in children. N Engl J Med 331:1500–1507

    Article  PubMed  CAS  Google Scholar 

  22. Pollack IF, Hoffman HJ, Humphreys RP, Becker L (1993) The long-term outcome after surgical treatment of dorsally exophytic brain-stem gliomas. J Neurosurg 8(6):859–863

    Google Scholar 

  23. Robertson PL, Allen JC, Abbott IR, Miller DC, Fidel J, Epstein FJ (1994) Cervicomedullary tumors in children: a distinct subset of brainstem gliomas. Neurology 44(10):1798–1803

    PubMed  CAS  Google Scholar 

  24. Robertson PL, Muraszko KM, Brunberg JA, Axtell RA, Dauser RC, Turrisi AT (1995) Pediatric midbrain tumors: a benign subgroup of brainstem gliomas. Pediatr Neurosurg. 22(2):65–73

    Article  PubMed  CAS  Google Scholar 

  25. Samii M, Eghbal R, Carvalho GA, Matthies C (2001) Surgical management of brainstem cavernomas. J Neurosurg 95:825–832

    PubMed  CAS  Google Scholar 

  26. Selvapandian S, Rajshekhar V, Chandy MJ (1999) Brainstem gliomas: comparative study of clinico-radiological presentation, pathology and outcome in children and adults. Acta Neurochirurgica 141:721–727

    Article  PubMed  CAS  Google Scholar 

  27. Shuper A, Kornreich L, Loven D, Michowitz S, Schwartz M, Cohen IJ (1998) Diffuse brain stem gliomas. Are we improving outcome. Child Nerv Syst 14(10):578–581

    Article  CAS  Google Scholar 

  28. Stroink AR, Hoffman HJ, Hendrick EB, Humphreys RP (1986) Diagnosis and management of pediatric bainstem gliomas. J Neurosurg 65:745–750

    PubMed  CAS  Google Scholar 

  29. Tortosa A, Vinolas N, Villa S, Verger E, Gil JM, Brell M, Caral L, Pujol T, Acebes JJ, Ribalta T, Ferrer I, Graus F (2003) Prognostic implication of clinical, radiologic, and pathologic features in patients with anaplastic gliomas. Cancer 97(4):1063–1071

    Article  PubMed  Google Scholar 

  30. Wang C, Zhang J, Liu A, Sun B, Zhao Y (2000) Surgical treatment of primary midbrain gliomas. Surg Neurol 53(1):41–51

    Article  PubMed  CAS  Google Scholar 

  31. Zimmerman RA (1996) Neuroimaging of pediatric brainstem diseases other than brainstem gliomas. Pediatr Neurosurgery 25:83–92

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Raj Kumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumar, R., Kalra, S.K. Pediatric brain stem lesions: introduction of a scoring system for clinical evaluation and their treatment analysis. Childs Nerv Syst 24, 467–475 (2008). https://doi.org/10.1007/s00381-007-0516-1

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-007-0516-1

Keywords

Navigation