Focal brain-stem astrocytomas causing symptoms of involvement of the facial nerve nucleus: long-term survival in six pediatric cases

J Neurosurg. 1994 Jan;80(1):20-5. doi: 10.3171/jns.1994.80.1.0020.

Abstract

Six children with a history of isolated facial nerve dysfunction or dizziness and nausea were treated for brain-stem glioma between 1984 and 1992. Computerized tomography and/or magnetic resonance (MR) imaging showed a focal, uniformly enhancing mass involving the facial nerve nucleus of the pons. All patients underwent biopsy; the histological diagnosis was juvenile pilocytic astrocytoma in five cases. In the remaining case the biopsy was nondiagnostic, although the surgeon believed that the lesion was a glioma. Postoperatively, five patients underwent conventional focal megavoltage radiation therapy (180 to 200 cGy/day) over a period of 5 1/2 weeks to a total dose of approximately 5400 cGy. One child's family refused radiation therapy; she remained well and stable for 4 years, despite persistent facial weakness, and was eventually lost to follow-up review. Four irradiation-treated patients had complete resolution of their tumors on MR images and have had no evidence of neuropsychological or neuroendocrinological deficits during 4 1/2 to 8 years of follow-up evaluation. Patients whose neuroradiological studies show a lesion resembling those in this series should undergo biopsy and, if the histology of a low-grade tumor (in particular, a juvenile pilocytic astrocytoma) is confirmed, should then receive focal radiation therapy with conventional megavoltage dosages.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Astrocytoma / complications*
  • Astrocytoma / diagnosis
  • Astrocytoma / mortality*
  • Astrocytoma / radiotherapy
  • Biopsy
  • Brain Neoplasms / complications*
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / mortality*
  • Brain Neoplasms / radiotherapy
  • Brain Stem*
  • Child
  • Child, Preschool
  • Facial Nerve Diseases / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Survival Rate
  • Tomography, X-Ray Computed
  • Treatment Outcome