Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Leptomeningeal Dissemination of a Low-Grade Brainstem Glioma without Local Recurrence

  • Moon, Jung-Ho (Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School) ;
  • Jung, Tae-Young (Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School) ;
  • Jung, Shin (Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School) ;
  • Jang, Woo-Youl (Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School)
  • Received : 2011.05.09
  • Accepted : 2012.02.07
  • Published : 2012.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

It is rare for low-grade gliomas to disseminate to the leptomeninges. However, low-grade gliomas with dissemination to the leptomeninges have been occasionally reported in children, and have generally been associated with local recurrence. A 16-year-old boy sought evaluation for diplopia and gait disturbance. A brain magnetic resonance imaging (MRI) revealed pontine mass, which was proved to be fibrillary astrocytoma on biopsy, later. Radiation therapy (5400 cGy) was given and the patient's symptoms were improved. He was followed-up radiologically for brain lesion. Seven months after diagnosis he complained of back pain and gait disturbance. A brain MRI showed a newly-developed lesion at the left cerebellopontine angle without an interval change in the primary lesion. A spinal MRI demonstrated leptomeningeal dissemination of the entire spine. Radiation therapy (3750 cGy) to the spine, and adjuvant chemotherapy with a carboplatin plus vincristine regimen were administered. However, he had a progressive course with tumoral hemorrhage and expired 13 months after diagnosis. We report an unusual case of a low-grade brainstem glioma with spinal dissemination, but without local recurrence, and a progressive course associated with hemorrhage.

Keywords

References

  1. Bell WO, Packer RJ, Seigel KR, Rorke LB, Sutton LN, Bruce DA, et al. : Leptomeningeal spread of intramedullary spinal cord tumors. Report of three cases. J Neurosurg 69 : 295-300, 1988 https://doi.org/10.3171/jns.1988.69.2.0295
  2. Cavaliere R, Lopes MB, Schiff D : Low-grade gliomas : an update on pathology and therapy. Lancet Neurol 4 : 760-770, 2005 https://doi.org/10.1016/S1474-4422(05)70222-2
  3. Civitello LA, Packer RJ, Rorke LB, Siegel K, Sutton LN, Schut L : Leptomeningeal dissemination of low-grade gliomas in childhood. Neurology 38 : 562-566, 1988 https://doi.org/10.1212/WNL.38.4.562
  4. Elliott JP, Keles GE, Waite M, Temkin N, Berger MS : Ventricular entry during resection of malignant gliomas : effect on intracranial cerebrospinal fluid tumor dissemination. J Neurosurg 80 : 834-839, 1994 https://doi.org/10.3171/jns.1994.80.5.0834
  5. Erlich SS, Davis RL : Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer 42 : 2854-2864, 1978 https://doi.org/10.1002/1097-0142(197812)42:6<2854::AID-CNCR2820420647>3.0.CO;2-4
  6. Eyre HJ, Crowley JJ, Townsend JJ, Eltringham JR, Morantz RA, Schulman SF, et al. : A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas : a Southwest Oncology Group study. J Neurosurg 78 : 909-914, 1993 https://doi.org/10.3171/jns.1993.78.6.0909
  7. Friedman HS, Krischer JP, Burger P, Oakes WJ, Hockenberger B, Weiner MD, et al. : Treatment of children with progressive or recurrent brain tumors with carboplatin or iproplatin : a Pediatric Oncology Group randomized phase II study. J Clin Oncol 10 : 249-256, 1992 https://doi.org/10.1200/JCO.1992.10.2.249
  8. Gajjar A, Bhargava R, Jenkins JJ, Heideman R, Sanford RA, Langston JW, et al. : Low-grade astrocytoma with neuraxis dissemination at diagnosis. J Neurosurg 83 : 67-71, 1995 https://doi.org/10.3171/jns.1995.83.1.0067
  9. Grabb PA, Albright AL, Pang D : Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 30 : 64-71, 1992 https://doi.org/10.1227/00006123-199201000-00012
  10. Hukin J, Siffert J, Velasquez L, Zagzag D, Allen J : Leptomeningeal dissemination in children with progressive low-grade neuroepithelial tumors. Neuro Oncol 4 : 253-260, 2002 https://doi.org/10.1093/neuonc/4.4.253
  11. Kyoshima K, Kobayashi S, Gibo H, Kuroyanagi T : A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions. Report of three cases. J Neurosurg 78 : 987-993, 1993 https://doi.org/10.3171/jns.1993.78.6.0987
  12. Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, et al. : Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus 4 : e3, 1998
  13. Packer RJ, Lange B, Ater J, Nicholson HS, Allen J, Walker R, et al. : Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol 11 : 850-856, 1993 https://doi.org/10.1200/JCO.1993.11.5.850
  14. Perilongo G, Gardiman M, Bisaglia L, Rigobello L, Calderone M, Battistella A, et al. : Spinal low-grade neoplasms with extensive leptomeningeal dissemination in children. Childs Nerv Syst 18 : 505-512, 2002 https://doi.org/10.1007/s00381-002-0626-8
  15. Perilongo G, Garrè ML, Giangaspero F : Low-grade gliomas and leptomeningeal dissemination : a poorly understood phenomenon. Childs Nerv Syst 19 : 197-203, 2003
  16. Russell DS, Rubinstein LJ : Pathology of Tumors of the Nervous System, ed 5. Baltimore : Williams & Wilkins, 1989, pp421-448.
  17. Saito R, Kumabe T, Jokura H, Shirane R, Yoshimoto T : Symptomatic spinal dissemination of malignant astrocytoma. J Neurooncol 61 : 227-235, 2003 https://doi.org/10.1023/A:1022536828345

Cited by

  1. Delayed leptomeningeal and subependymal seeding after multiple surgeries for supratentorial diffuse low-grade gliomas in adults : Clinical article vol.120, pp.4, 2012, https://doi.org/10.3171/2013.10.jns131512
  2. Massive leptomeningeal dissemination of a low-grade thalamic astrocytoma in an adult patient vol.115, pp.3, 2012, https://doi.org/10.1007/s13760-014-0379-7
  3. Endoscopic diagnosis of an MRI-occult, low-grade glioma with ependymal dissemination vol.16, pp.4, 2015, https://doi.org/10.3171/2015.3.peds14444
  4. Metastatic Low‐Grade Gliomas in Children: 20 Years' Experience at St. Jude Children's Research Hospital vol.63, pp.1, 2012, https://doi.org/10.1002/pbc.25731
  5. Serial imaging and management of ganglioglioma with unusual presentation and meningeal spread vol.159, pp.3, 2017, https://doi.org/10.1007/s00701-016-3017-8
  6. Endoscopic Treatment of an Adult with Tegmental Astrocytoma Accompanied by Cerebrospinal Fluid Dissemination vol.60, pp.3, 2012, https://doi.org/10.3340/jkns.2014.0808.026