Abstract
Infratentorial gliomas are relatively rare tumors compared to their supratentorial counterparts. As such they have not been extensively characterized as a group and are usually excluded from clinical studies. Using our database we aimed to characterize adult gliomas involving the posterior fossa with respect to their clinical behavior and prognostic factors. We reviewed our neurosurgical and neuro-oncological data bases for adult patients diagnosed with gliomas involving the posterior fossa between 1996 and 2010. Of 1,283 glioma patients, 57 patients with gliomas involving the posterior fossa were identified (4.4 %). Tumors were further classified by location as primary brainstem (n = 21) and primary cerebellar (n = 18) tumors. On univariate analysis survival was correlated to tumor grade and KPS. In addition we have identified a unique group of patients (n = 18) with previously diagnosed supratentorial gliomas who subsequently developed noncontiguous secondary infratentorial extension of their tumors with subsequent rapid clinical deterioration. Gliomas of the posterior fossa comprise a heterogeneous group of tumors. Histological grade of the tumor was found to be the main prognostic factor. Survival of primary cerebellar gliomas is comparable to supra-tentorial gliomas, while brainstem gliomas in adults fare better than in the pediatric population. Secondary extension of supratentorial gliomas to the posterior fossa signifies a grave prognosis.
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Porter KR, McCarthy BJ, Freels S, Kim Y, Davis FG (2010) Prevalence estimates for primary brain tumors in the United States by age, gender, behavior, and histology. Neuro-oncology 12(6):520–527
2010 CBTRUS Statistical Report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2006
Louis DN, Ohgaki H, Wiestler OD, Cavenee W (2007) WHO classification of tumours of the central nervous system, 4th edn. IARC Press, Lyon
Stark AM, Maslehaty H, Hugo HH, Mahvash M, Mehdorn HM (2010) Glioblastoma of the cerebellum and brainstem. J Clin Neurosci 17(10):1248–1251
Weber DC, Miller RC, Villà S, Hanssens P, Baumert BG, Castadot P et al (2006) Outcome and prognostic factors in cerebellar glioblastoma multiforme in adults: a retrospective study from the rare cancer network. Int J Radiat Oncol Biol Phys 66(1):179–186
Djalilian HR, Hall WA (1998) Malignant gliomas of the cerebellum: an analytic review. J Neurooncol 36(3):247–257
Levine SA, McKeever PE, Greenberg HS (1987) Primary cerebellar glioblastoma multiforme. J Neurooncol 5(3):231–236
Dirven CM, Mooij JJ, Molenaar WM (1997) Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nerv Syst 13(1):17–23
Due-Tønnessen BJ, Helseth E, Scheie D, Skullerud K, Aamodt G, Lundar T (2002) Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0–19 years): report of 110 consecutive cases. Pediatr Neurosurg 37(2):71–80
Pollack IF, Claassen D, al-Shboul Q, Janosky JE, Deutsch M (1995) Low-grade gliomas of the cerebral hemispheres in children: an analysis of 71 cases. J Neurosurg 82(4):536–547
Palma L, Celli P, Mariottini A (2004) Long-term follow-up of childhood cerebellar astrocytomas after incomplete resection with particular reference to arrested growth or spontaneous tumour regression. Acta Neurochir (Wien) 146(6):581–588
Guillamo JS, Doz F, Delattre JY (2001) Brain stem gliomas. Curr Opin Neurol 14(6):711–715
Laigle-Donadey F, Doz F, Delattre J-Y (2008) Brainstem gliomas in children and adults. Curr Opin Oncol 20(6):662–667
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJB et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996
Batzdorf U, Malamud N (1963) The problem of multicentric gliomas. J Neurosurg 20:122–136
Hefti M, von Campe G, Schneider C, Roelcke U, Landolt H (2010) Multicentric tumor manifestations of high grade gliomas: independent proliferation or hallmark of extensive disease? Cen Eur Neurosurg 71(1):20–25
Salvati M, Caroli E, Orlando ER, Frati A, Artizzu S, Ferrante L (2003) Multicentric glioma: our experience in 25 patients and critical review of the literature. Neurosurg Rev 26(4):275–279
Djalilian HR, Shah MV, Hall WA (1999) Radiographic incidence of multicentric malignant gliomas. Surg Neurol 51(5):554–557
Giese A, Westphal M (1996) Glioma invasion in the central nervous system. Neurosurgery 39(2):235–250
Roth J, Nass D, Ram Z (2006) Cerebellar tumor extension as a late event of long-standing, supratentorial low-grade gliomas: case report. Neurosurgery 58(6):E1210
Yan H, Parsons DW, Jin G, McLendon R, Rasheed BA, Yuan W et al (2009) IDH1 and IDH2 mutations in gliomas. N Engl J Med 360(8):765–773
Salunke P, Badhe P, Sharma A (2010) Cerebellar glioblastoma multiforme with non-contiguous grade 2 astrocytoma of the temporal lobe in the same individual. Neurol India 58(4):651–653
Selvapandian S, Rajshekhar V, Chandy MJ (1999) Brainstem glioma: comparative study of clinico-radiological presentation, pathology and outcome in children and adults. Acta Neurochir (Wien) 141(7):721–726
Guillamo JS, Monjour A, Taillandier L, Devaux B, Varlet P, Haie-Meder C et al (2001) Brainstem gliomas in adults: prognostic factors and classification. Brain 124(Pt 12):2528–2539
Kesari S, Kim RS, Markos V, Drappatz J, Wen PY, Pruitt AA (2008) Prognostic factors in adult brainstem gliomas: a multicenter, retrospective analysis of 101 cases. J Neurooncol 88(2):175–183
Salmaggi A, Fariselli L, Milanesi I, Lamperti E, Silvani A, Bizzi A et al (2008) Natural history and management of brainstem gliomas in adults. A retrospective Italian study. J Neurol 255(2):171–177
Demir MK, Hakan T, Akinci O, Berkman Z (2005) Primary cerebellar glioblastoma multiforme. Diagn Interv Radiol. 11(2):83–86
Chamberlain MC, Silver P, Levin VA (1990) Poorly differentiated gliomas of the cerebellum. A study of 18 patients. Cancer 65(2):337–340
Tsung AJ, Prabhu SS, Lei X, Chern JJ (2011) Benjamin Bekele N, Shonka NA. Cerebellar glioblastoma: a retrospective review of 21 patients at a single institution. J Neurooncol 105(3):555–562
Gopalakrishnan CV, Dhakoji A, Nair S, Menon G, Neelima R (2012) A retrospective study of primary cerebellar glioblastoma multiforme in adults. J Clin Neurosci 19(12):1684–1688
Jeswani S, Nuño M, Folkerts V, Mukherjee D, Black KL, Patil CG (2013) Comparison of survival between cerebellar and supratentorial glioblastoma patients: surveillance, epidemiology, and end results (SEER) analysis. Neurosurgery 73(2):240–246
Kopelson G, Linggood R (1982) Infratentorial glioblastoma: the role of neuraxis irradiation. Int J Radiat Oncol Biol Phys 8(6):999–1003
Fisher PG, Tihan T, Goldthwaite PT, Wharam MD, Carson BS, Weingart JD et al (2008) Outcome analysis of childhood low-grade astrocytomas. Pediatr Blood Cancer 51(2):245–250
Wade A, Hayhurst C, Amato-Watkins A, Lammie A, Leach P (2013) Cerebellar pilocytic astrocytoma in adults: a management paradigm for a rare tumour. Acta Neurochir (Wien) 155(8):1431–1435
Bagley JH, Babu R, Friedman AH, Adamson C (2013) Improved survival in the largest national cohort of adults with cerebellar versus supratentorial low-grade astrocytomas. Neurosurg Focus 34(2):E7
Ida CM, Lambert SR, Rodriguez FJ, Voss JS, Mc Cann BE, Seys AR et al (2012) BRAF alterations are frequent in cerebellar low-grade astrocytomas with diffuse growth pattern. J Neuropathol Exp Neurol 71(7):631–639
Korshunov A, Meyer J, Capper D, Christians A, Remke M, Witt H et al (2009) Combined molecular analysis of BRAF and IDH1 distinguishes pilocytic astrocytoma from diffuse astrocytoma. Acta Neuropathol 118(3):401–405
Sievert AJ, Fisher MJ (2009) Pediatric low-grade gliomas. J Child Neurol 24(11):1397–1408
Due-Tønnessen BJ, Lundar T, Egge A, Scheie D (2013) Neurosurgical treatment of low-grade cerebellar astrocytoma in children and adolescents: a single consecutive institutional series of 100 patients. J Neurosurg Pediatr 11(3):245–249
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Strauss, I., Jonas-Kimchi, T., Bokstein, F. et al. Gliomas of the posterior fossa in adults. J Neurooncol 115, 401–409 (2013). https://doi.org/10.1007/s11060-013-1231-2
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DOI: https://doi.org/10.1007/s11060-013-1231-2