Surgical intervention is possible for certain types of brainstem tumors. If the tumor is in the tectum of the midbrain, the tumor is usually slow growing and shows up when it causes hydrocephalus (fluid accumulation in the ventricles – fluid-filled compartments) by blocking the outflow tract usually utilized by circulating cerebrospinal fluid. Hydrocephalus is relieved by endoscopic third ventriculostomy (ETV) or ventricular shunt placement. A type of brainstem glioma growing backward out of the brainstem (called dorsal exophytic gliomas) is often a good candidate for surgical resection (removal). In these cases, at least a part of the tumor can be removed. Surgical resection is also typically recommended early for brainstem gliomas occurring at the junction of the brainstem and cervical spine (called cervicomedullary gliomas). Surgical procedures for resection of brainstem gliomas are highly involved and can take several hours. Following surgery, the exact molecular characteristics of the tumor (which influence prognosis and treatment options available) will be determined.
Surgical resection is not possible in DIPG because the normal brain tissue cannot be separated from the tumor. (More about DIPG.)
In many brainstem gliomas, tumor growth can block the normal cerebrospinal fluid (CSF) circulation, leading to a buildup of fluid pressure in the brain (hydrocephalus). Therefore, surgery for a brainstem glioma may include relieving hydrocephalus. Endoscopic third ventriculostomy (ETV) is the preferred method for treating hydrocephalus in these patients. If ETV is not possible, then placement of a shunt is the alternative. Shunts may sometimes need to be repositioned to continue to drain effectively, a procedure known as a shunt revision.
At Weill Cornell Medicine Neurological Surgery, our pediatric neurosurgeons are highly skilled in the most advanced procedures for treating brain tumors in children. (See Doctors Who Treat Pediatric Brain Tumors.)
Reviewed by: Umberto Tosi, MD
Last reviewed/last updated: September 2024
Illustration by Thom Graves, CMI
