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Principles of Brainstem Surgery

Last Updated: September 28, 2018

Brainstem Pilocytic Astrocytoma: Paramedian Supracerebellar Route

Brainstem gliomas include a collection of clinically and surgically heterogeneous tumors and are most commonly found in children. Approximately 10% to 20% of pediatric brain tumors fall into this category, presenting in patients with a mean age of 5 to 10 years old. Intrinsic tumors of the brainstem and cervicomedullary junction were largely considered inoperable before the modern neurosurgical era because of their poor postoperative prognosis and high surgical morbidity.

With the advent of magnetic resonance imaging (MRI), however, it became possible to delineate two key imaging features that are vital for surgical decision-making process in these tumors: precise anatomic location and a focal versus diffuse morphology....