gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Adult brainstem gliomas: a retrospective analysis of 110 cases within the German Glioma Network

Meeting Abstract

  • T. Reithmeier - Abteilung für Stereotaktische Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • A. Kuzeawu - Abteilung für Stereotaktische Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • H. Berger - Insitut für Medizinische Informatik, Statistik und Epidemologie, Universität Leipzig
  • M. Trippel - Abteilung für Stereotaktische Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • G. Nikkhah - Abteilung für Stereotaktische Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.09-03

doi: 10.3205/09dgnc169, urn:nbn:de:0183-09dgnc1693

Published: May 20, 2009

© 2009 Reithmeier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Adult brainstem gliomas are a very rare (<2% of gliomas). This is a poorly investigated disease. The aim of this retrospective study was to examine the sensitivity of the preoperative neuroradiological imaging in grading these tumors, the impact of different therapeutic strategies on the course of the disease and to define the value of a histopathologically proven diagnosis.

Methods: Between 1997 and 2007, 110 patients from 5 centers of the German Glioma Network (GGN) with a radiologically proven tumors of the brainstem were retrospectively analyzed with study-specific questionnaires. Data about the patients, the clinical course of the disease, the neuroradiological imaging, the therapeutic approaches and the neuropathological results were collected and analyzed with the assistance of the central database of the GGN. The sensitivity of the preoperative neuroradiological imaging to differentiate between high-grade and low-grade gliomas was calculated on the basis of the histopathological results.

Results: The median age of the patients at time of diagnosis was 41 years (range: 18–89 years), median Karnofsky performance status was 80 (range: 30–100). The main presenting symptoms were visual disturbances and diplopia (32%), disturbances of sensation (28%), weakness of the limbs (25%), gait disturbances (25%), pain (24%) and dizziness (21%). The histopathological diagnosis was glioblastoma in 12%, anaplastic astrocytoma in 34%, astrocytoma grade II in 27% and a pilocytic astrocytoma in 14%. A glial tumor without further grading was found in 8%, an ependymoma in 3% and in 2% the diagnosis of a tumor could not be confirmed by histopathological examination. The results of the preoperative magnetic resonance imaging were available in 55 patients. The sensitivity of the MRI for the diagnosis of a low-grade glioma was 41% and of a high-grade glioma 21%. Therapeutic concepts differed according to the histopathology of the disease. In general, most patients received either irradiation alone (grade I: 42%; grade II: 72%; grade III: 47%; grade IV: 33%) or in combination with chemotherapy (grade I: 0%; grade II: 10%; grade III: 28%; grade IV: 42%).

Conclusions: Due to the low sensitivity of magnetic resonance imaging in differentiating low-grade from high-grade gliomas, the histological examination of stereotactic biopsies is essential for the correct grading of intrinsic brain stem tumors, which has substantial impact on the therapeutic concept.