gms | German Medical Science

Objective: Gliomas of the posterior cranial fossa in adulthood are relatively rare tumours. The purpose of this study was to analyze our surgical experience in treating these tumours.

Methods: Thirty two consecutive patients with posterior fossa gliomas operated on between January 2004 and September 2008 in the Clinic of Neurosurgery at University Hospital „Sv. Ivan Rilsky“ were reviewed. The median age was 28 years (range, 18–79 yrs). The male:female ratio was 11:21. Headache, nausea and vomiting, and disequilibrium were the most frequent onset symptoms. The most common findings were ataxia and nystagmus. Based on the preoperative CT/MR images the brain stem was engaged by a tumour in 14 cases.

Results: Gross total resection was performed in 15 patients (47%), subtotal resection in 3 (9%), partial resection in 5 (16%) and biopsy in 5 patients (16%). The rest 4 cases (12%) underwent only neuroendoscopic third ventriculostomy. The histologically confirmed tumours were low grade in 75% and high grade in 25%. In the early postoperative period a favourable clinical outcome was defined in 26 patients, morbidity was 6% (2 pts) and mortality 3% (1 pt).

Conclusions: The technological advance in neuroimaging, neurosurgical armamentarium and operative neurosurgery allowed us to produce operative results with an admissible level of morbidity and mortality not conceivable just a few decades ago. The extent of resection of the posterior fossa gliomas in adulthood is significantly dependent on the tumour localization and dimensions, as the main restricting factor is the brain stem engagement.