Surgical treatment of brainstem gliomas in children

Brainstem gliomas have historically been some of the most difficult pediatric cancers to treat. Tumors arising in the brainstem were once uniformly discounted as surgically unapproachable lesions. The advent of magnetic resonance imaging and sophisticated neurophysiologic monitoring techniques has significantly advanced the surgical treatment of these precarious lesions. Brainstem gliomas are now recognized as a heterogenous group of tumors. They have been broadly classified in four categories: diffuse, focal, exophytic, and cervicomedullary. This classification system has provided a framework to predict growth patterns, surgical resectability, and overall prognosis. Although most remain unresectable, there are certain brainstem gliomas that are readily amenable to surgical therapy.