Brainstem Tumor Symptoms, Diagnosis, and Treatment Methods

The brainstem anatomically connects the brain to the spinal cord.

The brainstem anatomically connects the brain to the spinal cord. The structures in the brainstem include the medulla oblongata, pons, and reticular formation. The lowest part of the brainstem, where it connects to the spinal cord, is called the medulla oblongata.

It is the center for respiration and circulation. It controls the respiratory movements and the heart rate. The brainstem controls most of the body's basic functions, including hunger, thirst, body temperature, blood pressure, respiration, and more. The brainstem also passes the cranial nerves that connect to the head and neck muscles (such as those responsible for chewing, swallowing, and speaking) as well as the cranial nerves responsible for the senses of sight, hearing, and smell, which send signals to the brain.

Brainstem tumors account for 1.4% of all brain tumors. They constitute 10-25% of brain tumors in childhood. The majority of brainstem tumors are gliomas, which arise from glial (support) cells. There are several different types of glial tumors. Astrocytomas arise from star-shaped cells called astrocytes. In adults, they usually form in the brain, while in children, they occur in the brainstem, brain, and cerebellum.

The average 5-year survival rate for brainstem gliomas is reported to be 30%. Prior to the 1980s, brainstem tumors were generally considered inoperable. However, with advancements in neuroradiology and surgical techniques, certain brainstem tumors can now be surgically treated under specific conditions. Surgical treatment results are steadily improving and becoming more acceptable.

What are the Symptoms?

Generally, brainstem tumors present with very distinct symptoms. It is very difficult to detect them at an early stage without symptoms. Once the tumor starts to show symptoms, it can present with signs such as difficulty walking, weakness, instability, inability to stand, and swaying from side to side while walking. Additionally, depending on the tumor's spread and nerve involvement in this area, symptoms such as difficulty swallowing, difficulty speaking, facial paralysis, strabismus, and inability to look up or in/out with the eyes can be observed. In later stages, dramatic symptoms like paralysis in the arms and legs, bedridden dependency, and coma may occur.

What are the Risk Factors?

As with brain tumors, risk factors for brainstem tumors include radiation, radioactive rays, genetic factors, exposure to certain chemicals, and viral or microbial agents. However, the exact conditions under which these tumors develop are still not fully understood.

How is it Diagnosed?

As with all brain tumors, brainstem tumors are suspected based on a thorough neurological examination. Radiological diagnosis follows as a secondary step. Diagnostic methods for brainstem tumors include computerized brain tomography, magnetic resonance imaging (MRI), and angiography. With the advancement of imaging techniques, methods like PET, SPECT, MR spectroscopy, functional MRI, and cine MRI are now also used. MRI is employed to classify these tumors.

How is it Treated?

Brainstem tumors are classified into five types based on MRI findings. The treatment protocol is also based on these MRI findings. Diffuse (widespread) tumors, due to their behavior and location, are considered malignant, and surgical intervention is not recommended for these tumors. Focal tumors, although generally benign, are sometimes not completely removed due to surgical risks. Cystic tumors that extend into the neck and spinal cord region can be completely surgically removed. Postoperative radiation therapy is applied to these tumors. All of these tumors are sensitive to radiation. For most patients who do not undergo surgery, radiation therapy is applied. Like in brain tumors, stereotactic radiosurgery and CyberKnife methods are beneficial for these tumors.

Last Updated Date: 10 August 2016

Publication Date: 10 August 2016

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Brainstem Tumor Symptoms, Diagnosis, and Treatment Methods

What are the Symptoms?

What are the Risk Factors?

How is it Diagnosed?

How is it Treated?

Prof. Mehmet Çağlar Berk

Prof. Selçuk Göçmen

MD. Emre Zorlu

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