What is the best way to treat brain glioma?

After the occurrence of brain glioma, many people will often experience dizziness and headaches, and may even affect the health of their vision. Therefore, when necessary, appropriate methods should be chosen for treatment. The main categories include radiotherapy and surgical treatment, which are currently the more common treatment methods. Prognosis is also needed after treatment.

1. Radiotherapy is the first choice for solid tumors with low intracranial pressure and unclear boundaries. Generally, the total radiation dose should reach 50-55 Gy. Exceeding this dose will cause radiation necrosis. The irradiated area is usually the local brainstem tumor. Most patients experience improvement in clinical symptoms after radiotherapy, but the remission period usually does not exceed 8 months. In recent years, with the development of radiotherapy technology, the 5-year survival rate of radiotherapy alone has increased significantly, reaching as high as 40%.

2. Surgical treatment can be considered for those with tumors protruding from the surface of the brainstem or with cystic changes. The purpose of the surgery is to relieve the compression of the brainstem, restore the patency of cerebrospinal fluid circulation, and clarify the nature of the tumor. As much tumor as possible should be removed under a microscope without increasing neurological damage, and radiotherapy should be used postoperatively. Monitoring brainstem neurological function during surgery and using ultrasonic aspirator (CUSA) and laser to remove the tumor can reduce postoperative complications and mortality. In the early years, this group underwent surgical exploration in 47 cases, biopsy in 5 cases, partial resection in 35 cases, subtotal resection in 6 cases, and subtotal resection in 1 case. The mortality rate was 17% one month after surgery. With the application of microsurgery in recent years, the surgical mortality rate has dropped to below 1%. Due to the development of neurosurgical technology, the brainstem is no longer a restricted area for surgery. Many types of brainstem tumors, such as external growth type, cystic type and some localized type and cervicomedullary junction type tumors, can achieve a long survival period after surgery without other auxiliary treatments. For internal invasive tumors, surgery is not possible and radiation therapy is the main treatment option.

3. Chemotherapy Some people use chemotherapy combined with radiotherapy for unresectable pediatric brainstem tumors. The drugs used include vincristine, carmustine (carmustine), lomustine (cyclohexylnitrosourea), fluorouracil, etc., but the efficacy is not certain, so it is not routinely used clinically.

(II) Prognosis

The prognosis of pediatric brainstem glioma is mainly related to the pathological nature, location, size, surgical technique and postoperative adjuvant therapy of the tumor. In 1980, Kim et al. reported that after radiotherapy (dose greater than 50 Gy) for 63 cases of brainstem tumors, the 3-year survival rate was 40%; the 5-year survival rate was 35%; and the 10-year survival rate was 28%. In 1990, Packer reported that after radiotherapy (dose of 72 Gy) for 31 children with brainstem gliomas, the 2-year survival rate was 32%. Because different treatment plans are adopted, the reported survival rates vary, but there is a consensus that the prognosis of pediatric brainstem gliomas is poor.