Children who show symptoms of a brainstem tumor should be evaluated first with a thorough physical and neurological exam by his or her pediatrician. The pediatrician may order imaging studies and refer the child to a specialist for consultation.
The diagnosis of a brainstem glioma requires a magnetic resonance imaging (MRI) scan. Sometimes a CT scan is also ordered, since the test is quicker and more commonly available. An MRI scan produces detailed images of the brain and spine and allows doctors to detect the presence of a tumor. It is noninvasive but requires the patient to be still for the time in a scanner to produce slices of clear images that are then combined into three-dimensional pictures. Therefore, young children may require sedation for the scan. Oftentimes the child will need a special contrast agent to increase the visibility of any abnormality found. MRI scans are not only important in diagnosing a brainstem glioma, but also in determining whether surgical intervention is needed and feasible.
If the child’s symptoms and MRI studies are not typical, a stereotactic biopsy may be required to make a diagnosis. In this case, a pediatric neurosurgeon drills a small hole in the skull and inserts a needle to take a small piece of tissue for testing. A pathologist will examine the sample and make a diagnosis.
Treatment Options
Brainstem tumor patients are cared for by a multidisciplinary team including neurosurgeons, non-surgical specialists and other therapists. Treatment of brainstem gliomas includes surgery when feasible, management of pain and motor impairment, relief of hydrocephalus, and general support to improve quality of life.
Radiation therapy is the standard of care for the specific type of brainstem tumor known as DIPG, but it is not recommended as an early treatment for non-DIPG brainstem gliomas unless the tumor is high grade. (Find out more about DIPG.) It is also used later in the course of the disease, when a brainstem tumor has progressed. Radiation is usually avoided in children below age three because it may have long-term consequences for their development. Stereotactic radiosurgery is also used in certain cases (see more about our Stereotactic Radiosurgery Program).
Chemotherapy has limited use in the management of brainstem gliomas. It is mainly used for high-grade tumors or at later stages of the disease; its effectiveness is still the matter of numerous studies.
Surgical intervention is possible for certain types of brainstem gliomas (see Surgery for a Brainstem Glioma), but not usually for DIPG.
Reviewed by: Umberto Tosi, MD
Last reviewed/last updated: September 2024
Illustration by Thom Graves, CMI
