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Surgery for Gliomas and Other Mass Lesions of the Brainstem

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 22))

Abstract

In broad outline, the purpose of this chapter is first, to offer a review of past philosophies in the management of brainstem tumours, covering roughly the last half-century; next, to revisit the functional neuroanatomy of the brainstem in relation to modern neurosurgical applications; and finally, to present and discuss specific microsurgical techniques that we have used in 130 cases to date. This latter aspect is still open to much discussion and even controversy as many readers continue to believe that surgery for intra-axial brainstem tumours carries too high a risk and is of doubtful ethical justification. The most stringent opinions hold that the brainstem should be not violated even to obtain biopsy samples or perform partial removal of the tumour.

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References

  1. Abramson N, Raben M, Cavanaugh PJ (1974) Brain tumours in children: analysis of 136 cases. Radiology 112: 669–672

    PubMed  CAS  Google Scholar 

  2. Aitken L (1979) The auditory midbrain. Trends Neurosci 2: 308–310

    Article  Google Scholar 

  3. Albright AL, Price RA, Guthkelch AN (1983) Brain stem gliomas of children. A clinicopathological study. Cancer 52: 2313–2319

    Article  PubMed  CAS  Google Scholar 

  4. Albright AL, Schlabassi RJ (1985) Use of the cavitron ultrasonic aspirator and evoked potentials for treatment of thalamic and brainstem tumours in children. Neurosurgery 17: 564–568

    Article  PubMed  CAS  Google Scholar 

  5. Albright AL, Guthkelch AN, Packer RJ, et al (1986) Prognostic factors in pediatric brain-stem gliomas. J Neurosurg 65: 751–755

    Article  PubMed  CAS  Google Scholar 

  6. Alemà G, Perria L, Rosadini G, Rossi GF, Zattoni J (1966) Functional inactivation of human brain stem related to the level of consciousness. J Neurosurg 24: 629–639

    Article  PubMed  Google Scholar 

  7. Alpers BJ (1942) Partial paralysis of upward gaze. Confin Neurol (Basel) 5: 1–12

    Article  Google Scholar 

  8. Alpers BJ, Yaskin GC (1939) Gliomas of the pons. Arch Neurol Psychiat 41: 435–459

    Google Scholar 

  9. Alphin TH, William TB (1944) The course of the striae medullares in the human brain. J Comp Neurol 80: 65–68

    Article  Google Scholar 

  10. Alvisi C (1962) Considerazioni sul trattamento chirurgico dei gliomi bulbo-pontini. Min Neurochir 6: 5–7

    CAS  Google Scholar 

  11. Alvisi C, Cerisoli M, Maccheroni ME (1985) Long-term results of surgically treated brainstem gliomas. Acta Neurochir (Wien) 76: 12–17

    Article  CAS  Google Scholar 

  12. Anson JA, Spetzler RF (1993) Surgical resection of intramedullary spinal cord cavernous malformations. J Neurosurg 78: 446–451

    Article  PubMed  CAS  Google Scholar 

  13. Archer CR, Roberson GH, Taveras JN (1972) Posterior medullary heman-gioblastoma. Radiology 103: 323–328

    PubMed  CAS  Google Scholar 

  14. Arseni C, Goldberg M (1959) Psychic disturbances in infiltrative gliomata of the brain stem. Acta Neurochir (Wien) 7: 292–300

    Article  CAS  Google Scholar 

  15. Arseni C, Stanciu M (1973) Primary haematomas of the brain stem. Acta Neurochir (Wien) 28: 323–330

    Article  CAS  Google Scholar 

  16. Atkinson WJ (1949) The anterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 12: 137–151

    Article  PubMed  CAS  Google Scholar 

  17. Atlas SW, Grossman RI, Savino PJ, et al (1987) Internuclear ophthalmoplegia: MR-anatomic correlation. AJNR 8: 243–247

    PubMed  CAS  Google Scholar 

  18. Baghai P, Vries JK, Bechtel PC (1982) Retromastoid approach for biopsy of brain stem tumours. Neurosurgery 10: 574–579

    Article  PubMed  CAS  Google Scholar 

  19. Bailey P, Buchanan DN, Bucy PC (1939) Intracranial tumours of infancy and versity childhood. University Press, Chicago, pp 188–241

    Google Scholar 

  20. Baker GS (1965) Physiologic abnormalities encountered after removal of brain tumours from the floor of the fourth ventricle. J Neurosurg 23: 338–343

    Article  PubMed  CAS  Google Scholar 

  21. Baker R, Berthoz A (1975) Is the prepositus hypoglossi nucleus the source of another vestibulocular pathway? Brain Res 86: 121–127

    Article  PubMed  CAS  Google Scholar 

  22. Barnett HJ, Hyland HH (1952) Tumours involving the brainstem. Quart J Med 21: 265–284

    PubMed  CAS  Google Scholar 

  23. Becker DH, Silverberg GD (1978) Successful evacuation of an acute pontine hematoma. Surg Neurol 10: 263–265

    PubMed  CAS  Google Scholar 

  24. Berger MS, Edwards MSB, La Masters D, et al (1983) Pediatric brain stem tumours: radiographic, pathological and clinical correlations. J Neurosurg 12: 298–302

    Article  CAS  Google Scholar 

  25. Bilaniuk LT, Zimmerman RA, Littman P, Gallo E, Rorke LB, Bruce DA, Schut L (1980) Computed tomography of brain stem gliomas in children. Radiology 134: 89–95

    PubMed  CAS  Google Scholar 

  26. Bodensteiner J, Bell WE, Hart MN (1977) 13-year survival of a child with an untreated brainstem glioma. Letter. J Pediatr 90: 842–843

    Article  PubMed  CAS  Google Scholar 

  27. Bodian M, Lawson D (1953) The intracranial neoplastic diseases of childhood. Br J Surg 40: 368–392

    Article  PubMed  CAS  Google Scholar 

  28. Bouchard J (1966) Radiation therapy of tumours and disease of the nervous system. Lea and Febiger, Philadelphia, pp 119–135

    Google Scholar 

  29. Bray PF, Carter S, Taveras JM (1958) Brainstem tumours in children. Neurology 8: 17

    Google Scholar 

  30. Bricolo A (1975) Neurosurgical exploration and neurological pathology as a means for investigating human sleep semiology and mechanisms. In: Lairy GC, Salzarulo P (eds) Experimental study of human sleep: methodological problems. Elsevier, Amsterdam, pp 51–82

    Google Scholar 

  31. Bricolo A (1976) Prolonged post-traumatic coma. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. Injuries of the brain and skull, part II. North-Holland, Amsterdam, pp 699–755

    Google Scholar 

  32. Bricolo A, Turazzi S (1987) Esperienza nella chirurgia dei gliomi del tronco cerebrale. In: Attualità in neurochirurgia. Monduzzi, Bologna, pp 45–50

    Google Scholar 

  33. Bricolo A, Turazzi S, Cristofori L, et al (1991) Direct surgery for brainstem tumours. Acta Neurochir (Wien) [Suppl] 53: 148–158

    CAS  Google Scholar 

  34. Bricolo A, Turazzi S, Christofori L, Talacchi A, Berlucchi S (1993) Surgical treatment of brainstem tumours: experience in 75 patients. Abstract, AANS 61st Annual Meeting, Boston, April 24–29

    Google Scholar 

  35. Brodal A (1969) Neurological anatomy in relation to clinical medicine, 2nd Ed. Oxford University Press, New York, p 807

    Google Scholar 

  36. Buckley RC (1930) Pontine gliomas: a pathologic study and classification of twenty-five cases. Arch Pathol Lab Med 9: 779–819

    Google Scholar 

  37. Bucy PC (1957) Is there a pyramidal tract? Brain 80: 376–392

    Article  PubMed  CAS  Google Scholar 

  38. Bucy PC, Keplinger JE (1961) Section of the cerebral peduncles. Arch Neurol 5: 132–139

    Google Scholar 

  39. Bucy PC, Ladpli R, Ehrlich A (1966) Destruction of the pyramidal tract in the monkey. The effects of bilateral section of the cerebral peduncles. J Neurosurg 25: 1–20

    Article  PubMed  CAS  Google Scholar 

  40. Burns J, Lisak R, Schut L, et al (1980) Recovery following brainstem hemorrhage. Ann Neurol 7: 183–184

    Article  PubMed  CAS  Google Scholar 

  41. Chou SN, Erickson DL, Ortiz-Suarez HJ (1975) Surgical treatment of vascular lesions in the brain stem. J Neurosurg 42: 23–31

    Article  PubMed  CAS  Google Scholar 

  42. Clark WK (1987) Occipital transtentorial approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams and Wilkins, Los Angeles, pp 591–610

    Google Scholar 

  43. Dandy WE (1966) The brain. Prior, Hagerstown, pp 452–458

    Google Scholar 

  44. Doczi T, Thomas DGT (1979) Successful removal of an intrapontine haematoma. J Neurol Neurosurgy Psychiatry 42: 1058–1061

    Article  CAS  Google Scholar 

  45. Dogliotti M (1938) First surgical section in man of lemniscus lateralis. Curr Res Anesth Analg 17: 143

    Google Scholar 

  46. Durwood QJ, Barnett HJM, Barr HWK (1982) Presentation and management of mesencephalic hematoma. Report of two cases. J Neurosurg 56: 123–127

    Article  Google Scholar 

  47. Duvernoy HM (1978) Human brainstem vessels. Springer, Berlin Heidelberg New York

    Google Scholar 

  48. Edwards MSB, Prados M (1987) Current management of brainstem gliomas. Pediatr Neurosci 13: 309–315

    Article  PubMed  CAS  Google Scholar 

  49. Edwards MSB, Wara WM, Urtasun RC, Prados M, Levin Va, Funton D, Wilson CB, Hannigan J, Silver P (1989) Hyperfractionated radiation therapy for brainstem glioma: a phase I-II trial. J Neurosurg 70: 691–700

    Article  PubMed  CAS  Google Scholar 

  50. Eifel PJ, Cassady JR, Belli JA (1987) Radiation therapy of tumours of the brainstem and midbrain in children: experience of the joint center for radiation therapy and childrens’s hospital medical center (1971–1981). Int J Radiat Oncol Biol Phys 13: 847–852

    Article  PubMed  CAS  Google Scholar 

  51. Entzian W (1983) Removal of intraponto-mesencephalic spongioblastoma. Neurosurg Rev 6: 67–70

    Article  PubMed  CAS  Google Scholar 

  52. Epstein F, McCleary EL (1986) Intrinsic brain-stem tumours of childhood: surgical indications. J Neurosurg 64: 11–15

    Article  PubMed  CAS  Google Scholar 

  53. Epstein F, Wisoff J (1987) Intra-axial tumours of the cervicomedullary junction. J Neurosurg 67: 483–487

    Article  PubMed  CAS  Google Scholar 

  54. Epstein FJ, Wisoff JH (1989) Brainstem tumours in childhood: surgical indications. In: McLaurin RL, Schut L, Venes JL, et al (eds) Pediatric neurosurgery. Surgery of the developing nervous system, 2nd Ed. Saunders, Philadelphia, pp 357–365

    Google Scholar 

  55. Epstein F, Farmer JP (1993) Brain-stem glioma growth patterns. J Neurosurg 78: 408–412

    Article  PubMed  CAS  Google Scholar 

  56. Fahlbusch SC, Strauss C, Huk W, Rockelein G, Kompf D, Ruprecht RW (1990) Surgical removal of pontomesencephalic cavernous hemangiomas. Neurosurger 26: 449–457

    Article  CAS  Google Scholar 

  57. Fahlbusch R, Strauss C (1991) Zur chirurgischen Bedeutung von cavernösen Hämangiomen des Hirnstammes. Zentralbl Neurochir 52: 25–32

    PubMed  CAS  Google Scholar 

  58. Falconer MA (1949) Intramedullary trigeminal tractotomy and its place in the treatment of facial pain. J Neurol Neurosurg Psychiatry 12: 297–311

    Article  PubMed  CAS  Google Scholar 

  59. Fisher CM (1967) Some neuro-ophthalmological observations. J Neurol Neurosurg Psychiatry 30: 383–392

    Article  PubMed  CAS  Google Scholar 

  60. Foerster O, Gagel O (1940) Die encephalen Tumoren der Oblongata, Pons und des Mesencephalons. Ztschr Ges Neurol Psychiat 168: 295–331

    Article  Google Scholar 

  61. Fulton DS, Levin VA, Wara WM (1981) Chemotherapy of pediatric brainstem tumour. J Neurosurg 54: 721–725

    Article  PubMed  CAS  Google Scholar 

  62. Gaskell WH (1889) On the relation between the structure, function, distribution and origin of the cranial nerves; together with a theory of the origin of the nervous system of vertebrata. J Physiol 10: 153–211

    PubMed  CAS  Google Scholar 

  63. Gibbs FA (1932) Frequency with which tumours in various parts of the brain produce certain symptoms. Arch Neurol Psychiat 28: 969–989

    Google Scholar 

  64. Golden GS, Ghatak NR, Hirano A, French JH (1972) Malignant glioma of the brain stem: a clinicopathological analysis of 13 cases. J Neurol Neurosurg Psychiatry 35: 732–738

    Article  PubMed  CAS  Google Scholar 

  65. Greenberger JS, Cassady JR, Levene MB (1977) Radiation therapy of thalamic, midbrain and brain stem gliomas. Radiology 1222: 463–468

    Google Scholar 

  66. Guy G, Jan M, Guegan Y (1989) Les lésions chirurgicales du tronc cérébral. Neurochirurgie 35 [Suppl 1]: 1–33

    PubMed  Google Scholar 

  67. Hacker RJ, Fox JI (1980) Surgical treatment of brain stem carcinoma: case report. Neurosurgery 6: 430–432

    Article  PubMed  CAS  Google Scholar 

  68. Halperin EC (1985) Pediatric brain stem tumours: patterns of treatment failure and their implications for radiotherapy. Int Radiat Oncol Biol Phys 11: 1293–1298

    Article  CAS  Google Scholar 

  69. Hara M, Takeuchi K (1977) A temporal study of survival of patients with pontine gliomas. J Neurol 216: 189–196

    Article  PubMed  CAS  Google Scholar 

  70. Hare CC, Wolf A (1934) Intramedullary tumours of the brain stem. Arch Neurol Psychiat 32: 1230–1252

    Google Scholar 

  71. Hefez DS, Zinreich SH, Long DM (1990) Surgical resection of intrinsic brainstem lesions: an overview. Neurosurgery 27: 789–799

    Article  Google Scholar 

  72. Henschen F (1955) Tomoren des Zentalnervensystems und seiner Hüllen, III G, Tumoren der Brücke. In: Lubarsch O, Henke F, Rossle R (eds) Handbuch der speziellen pathologischen Anatomie und Histologie. Springer, Berlin Göttingen Heidelberg, pp 743–749

    Google Scholar 

  73. Herrick CJ (1899) The cranial and first spinal nerves of menidia. J Comp Neurol ix: 153–455

    Article  Google Scholar 

  74. Herrick CJ (1913) Anatomy of the brain. In: The reference handbook of the medical sciences, Vol 2. Wood, New York, pp 274–342

    Google Scholar 

  75. Hitchcock ER (1970) Stereotactic trigeminal tractotomy. Ann Clin Res 2: 131–135

    PubMed  CAS  Google Scholar 

  76. Hodge CJ, Primrose D (1993) Infratentorial procedures: physiological considerations: In: Apuzzo MLJ (ed) Brain Surgery. Churchill, Livingstone New York, pp 1569–1590

    Google Scholar 

  77. Hoffmann HJ, Becker L, Craven MA (1980) A clinically and pathologically distinct group of benign brain stem gliomas. Neurosurgery 7: 243–248

    Article  Google Scholar 

  78. Horrax G (1927) Differential diagnosis of tumours primarily pineal and primarily pontine. Arch Neurol Psychiat 17: 179–192

    Google Scholar 

  79. Humphreys RP (1978) Computerized tomographic definition of mesencephalic hematoma with evacuation through peduncolotomy. Case report. J Neurosurg 49: 749–772

    Article  PubMed  CAS  Google Scholar 

  80. Hutchins B, Weber JT (1985) The pretectal complex of the monkey: a reinvestigation of the morphology and retinal terminations. J Comp Neurol 232: 425–442

    Article  PubMed  CAS  Google Scholar 

  81. Ingraham FD, Matson DD (1954) Neurosurgery of infancy and childhood. Thomas, Springfield, p 259

    Google Scholar 

  82. Ishii N, Rapin I (1971) Cystic astrocytoma of the brain stem. Neuropaediatrie 3: 217–229

    Article  Google Scholar 

  83. Jackson IJ, Thomson RK (1959) Pediatric neurosurgery. Thomas, Springfield

    Google Scholar 

  84. Jamieson KG (1971) Excision of pineal tumours. J Neurosurg 35: 50–553

    Google Scholar 

  85. Jefferson G (1938) Tentorial pressure cone. Arch Neurol Psychiat 40: 857–876

    Google Scholar 

  86. Jefferson G, Johnson RT (1950) The cause of loss of consciousness in posterior fossa compressions. Folia Psychiat Neurol Neurochir Neerlandica 53: 306–319

    CAS  Google Scholar 

  87. Jelsma RK, Jelsma LF, Johnson GS (1993) Surgical removal of brainstem astrocytomas and hemangioblastomas: report of three cases and review. Surg Neurol 39: 494–510

    Article  PubMed  CAS  Google Scholar 

  88. Jenkin RDT, Boesel C, Ertel I, Evans A, Hittle R, Ortega J, Sposto R, Wara W, Wilson CB, Anderson J, Leikin S, Hammond D (1987) Brain tumours in childhood: a prospective randomized trial of irradiation with and without ajuvant CCNU, VCR, and prednisone. A report of the children’s cancer study group. J Neurosurg 66: 227–233

    Article  PubMed  CAS  Google Scholar 

  89. Jooma R, Torrens MJ, Bradshow J, Brownell B (1985) Subependymomas of the fourth ventricle. Surgical treatment in 12 cases. J Neurosurg 62: 508–512

    Article  PubMed  CAS  Google Scholar 

  90. Kashiwagi S, Van Loveren HA, Tew JM Jr, Wiot JG, Weil SM, Lukin RA (1990) Diagnosis and treatment of vascular brainstem malformations. J Neurosurg 72: 27–34

    Article  PubMed  CAS  Google Scholar 

  91. Keim H, Potthof PC, Schmidt K, Schiebusch M, Neiss A, Trott KR (1987) Survival and quality of life after continuous accelerated radiotherapy of glioblastomas. Radiother Oncol 9: 21–26

    Article  PubMed  CAS  Google Scholar 

  92. Kempe LG (1964) Surgical removal of an intramedullary haematoma simulating Wallenberg’s syndrome. J Neurol Neurosurg Psychiatry 27: 78–80

    Article  PubMed  CAS  Google Scholar 

  93. Kempe LG (1970) Operative neurosurgery, Vol 2. Springer, Berlin Heidelberg New York, pp 14–17

    Google Scholar 

  94. Kim TH, Chi HW, Pollan S, Hazel JH, Webster JH (1980) Radiotherapy of primary brain stem tumours. Int J Radiat Oncol Biol Phys 6: 51–57

    PubMed  CAS  Google Scholar 

  95. Konovalov A, Atieh J (1988) The surgical treatment of primary brain stem tumours. In: Schmideck HH, Sweet WH (eds) Operative neurosurgical techniques, 2nd Ed. Grune and Stratton, New York, pp 709–737

    Google Scholar 

  96. Konovalov A, Spallone A, Makhmudov UB, Kukhlajeva J A, Orezova VI (1990) Surgical management of hematomas of the brain stem. J Neurosurg 73: 181–186

    Article  PubMed  CAS  Google Scholar 

  97. Koos WT, Sunder-Plassmann M, Salah S (1969) Successful removal of a large intrapontine hematoma. Case report. J Neurosurg 31: 690–694

    Article  PubMed  CAS  Google Scholar 

  98. Koos WT, Miller MH (1971) Intracranial tumours of infants and children. Thieme, Stuttgart, pp 346–350

    Google Scholar 

  99. Krause F (1926) Operative Freilegung der Vierhugen, nebst Beobachtungen über Hirndruck und Dekompression. Zentralbl Chir 53: 2812–2819

    Google Scholar 

  100. Kucharczyk W, Brandt-Zawadzki M, Sobel D, Edwards MSB, Kelly W, Norman D, Newton TH (1985) Central nervous system tumours in children: detection by magnetic resonance imaging. Radiology 155: 131–136

    PubMed  CAS  Google Scholar 

  101. Kudo M (1981) Projections o the nuclei of the lateral lemniscus in the cat: an autoradiographic study. Brain Res 221: 57–69

    Article  PubMed  CAS  Google Scholar 

  102. Kunc Z (1965) Treatment of essential neuralgia of the 9th nerve by selective tractotomy. J Neurosurg 23: 494–500

    Article  PubMed  CAS  Google Scholar 

  103. Kunc Z (1966) Significance of fresh anatomic data on spinal trigeminal tract for possibility of selective tractotomies. In: Knighton RS, Dumke PR (eds) Little Brown, Boston, pp 351–363

    Google Scholar 

  104. Kunc Z, Marsala J (1962) La localisation et la terminaison des voies afférentes des nerfs IX et X dans le bulbe. Acta Neurochir (Wien) 19: 512–522

    Article  Google Scholar 

  105. Kyoshima K, Kobayashi S, Gibo H, Kuroyanagi T (1993) A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions. J Neurosurg 78: 987–993

    Article  PubMed  CAS  Google Scholar 

  106. Lang J (1991) Clinical anatomy of the posterior cranial fossa and its foramina. Thieme, Stuttgart

    Google Scholar 

  107. Lang J Jr, Ohmachi N, Lang J Sr (1991) Anatomical landmarks of the rhomboid fossa (floor of the 4th ventricle), its length and its width. Acta Neurochir (Wien) 113: 84–90

    Article  Google Scholar 

  108. Langmoen IA, Lundar T, Storm-Mathisen I, et al (1991) Management of pediatric pontine gliomas. Childs Nerv Syst 7: 13–15

    Article  PubMed  CAS  Google Scholar 

  109. Lapras C, Patet JD (1987) Controversies, techniques and strategies for pineal tumour surgery. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams and Wilkins, Los Angeles, pp 649–662

    Google Scholar 

  110. Lassiter KRL, Alexander E Jr, Davis CH Jr, Kelly DL Jr (1971) Surgical treatment of brain stem gliomas. J Neurosurg 34: 719–725

    Article  PubMed  CAS  Google Scholar 

  111. Lassman LP (1974) Tumours of the pons and medulla oblongata. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 17. North Holland, Amsterdam, pp 693–706

    Google Scholar 

  112. Lassman LP, Arjona VE (1967) Pontine gliomas of childhood. Lancet I:913–915

    Google Scholar 

  113. Le Beau J (1938) L’oedème du cerveau. Son rôle dans l’evolution des tumeurs et des abcés intra-craniens. Thèse de Paris, 233 pp

    Google Scholar 

  114. Levin VA, Edwards MSB, Wara WM, et al (1984) 5-Flurouracil and 1 (2-chloroethil)3cyclohexyllnitrosourea (CCNU) followed by hydroxyurea, misonidazole, and irradiation for brain stem gliomas: a pilot study of the Brain Tumour Research Center and the Children’s Cancer Group. Neurosurgery 14: 679–681

    Article  PubMed  CAS  Google Scholar 

  115. Lindheimer JH, Barrows HS (1962) Recurrent pontine hemorrhage incident to venous angioma of the pons: report of a case. Bull LA Neurol Soc 27: 128–133

    CAS  Google Scholar 

  116. Lister JR, Rhoton AL Jr, Matsushima T, Peace D (1982) Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery 10: 179–199

    Google Scholar 

  117. Littman P, Jarret P, Bilaniuk L, et al (1980) Pediatric brain stem gliomas. Cancer 45: 2787–2792

    Article  PubMed  CAS  Google Scholar 

  118. Luse SA, Teitelbaum S (1968) Congenital glioma of brain stem. Arch Neurol (Chic) 18: 196–201

    CAS  Google Scholar 

  119. Mantravadi RV, Phatak R, Bellur S, Liebner EJ, Haas R (1982) Brain stem gliomas: an autopsy study of 25 cases. Cancer 49: 1294–1296

    Article  PubMed  CAS  Google Scholar 

  120. Marsa GW, Probert JC, Rubinstein LC, Bagshaw MA (1973) Radiation therapy in the treatment of childhood astrocytic gliomas. Cancer 32: 646–654

    Article  PubMed  CAS  Google Scholar 

  121. Martin JH (1989) Neuroanatomy, text and atlas. Elsevier, New York

    Google Scholar 

  122. Martini PM (1971) L’hématome bulbotubérantiel opérable. Acta Neurol Belg 71: 261–268

    Google Scholar 

  123. Matson DD (1969) Neurosurgery of infancy and childhood, 2nd Ed. Thomas, Springfield, pp 469–477

    Google Scholar 

  124. Matsushima T, Rhoton AL Jr, Lenkey C (1982) Microsurgery of the fourth ventricle. Part I: Microsurgical anatomy. Neurosurgery 11: 631–667

    Article  PubMed  CAS  Google Scholar 

  125. Matsushima T, Fukui M, Inoue T, Natori Y, Baba T, Fujii K (1992) Microsurgical and magnetic resonance imaging anatomy of the cerebellomedullary fissure and its application during fourth ventricle surgery. Neurosurgery 30: 325

    Article  PubMed  CAS  Google Scholar 

  126. Mazars G, Pansini A, Chiarelli J (1959) Coagulation du faisceau spinotha-lamique et du faisceau quintothalamique par stereotaxie. Rev Neurol (Paris) 100: 516

    Google Scholar 

  127. McComb JG, Apuzzo MLJ (1987) Posterior intrahemispheric retrocallosal and transcallosal approaches. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams and Wilkins, Los Angeles, pp 611–641

    Google Scholar 

  128. Milhorat TH (1975) Pontine glioma (letter to editor). JAMA 32: 595–596

    Google Scholar 

  129. Moruzzi G, Magoun HW (1949) Brain stem reticular formation and activation of the EEG. Electroenceph Clin Neurophysiol 1: 455–473

    PubMed  CAS  Google Scholar 

  130. Mundinger F, Kraus DF, Krauss JK, Birg W (1991) Long-term outcome of 89 low-grade brainstem gliomas after interstitial radiation therapy. J Neurosurg 75: 740–746

    Article  PubMed  CAS  Google Scholar 

  131. Murphy MG(1972) Successful evacuation of acute pontine hematoma. Case report. J Neurosurg 37: 224–225

    Article  PubMed  CAS  Google Scholar 

  132. Myers J, Scott M, Silverstein A (1961) A cystic hemangioblastoma of pons. J Neurosurg 18: 694–697

    Article  PubMed  CAS  Google Scholar 

  133. Nakamura N, Sekino H, Yaguchi Y, Fuse T (1985) Successful total extirpation of hemangioblastoma originating in the medulla oblongata. Surg Neurol 24: 87–94

    Article  PubMed  CAS  Google Scholar 

  134. Nashold BS Jr (1972) Defects of ocular motility after stereotactic midbrain lesions in man. Arch Ophthal (Chic) 88: 245–256

    Google Scholar 

  135. Nieuwenhuys R (1974) Topological analysis of the brain stem: a general introduction. J Comp Neurol 156: 255–276

    Article  PubMed  CAS  Google Scholar 

  136. Nieuwenhuys R, Voogd J, Van Huijzen Chr (1988) The human central nervous system. A synopsis and atlas, 3rd Ed. Springer, Berlin Heidelberg New York Tokyo

    Google Scholar 

  137. Northield DWC (1973) The surgery of central nervous system. Blackwell, London

    Google Scholar 

  138. Obana WG, Wilson CB (1991) Epidermoid cysts of the brainstem. J Neurosurg 74: 123–128

    Article  PubMed  CAS  Google Scholar 

  139. Obrador S, Dierssen G, Ordoriz BJ (1970) Surgical evacuation of a pontinemedullary hematoma. Case report. J Neurosurg 33: 82–84

    Article  PubMed  CAS  Google Scholar 

  140. O’Laoire SA, Crockard HA, Thomas DGT, et al (1982) Brainstem hematoma. A report of six surgically treated cases. J Neurosurg 56: 222–227

    Article  PubMed  Google Scholar 

  141. Olivecrona H (1942) Tractotomy for relief of trigeminal neuralgia. Arch Neurol Psychiat (Chic) 47: 544–564

    Google Scholar 

  142. Olivecrona H (1967) Handbuch der Neurochirurgie, Band 4, Teil 4. Springer, Berlin Heidelberg

    Google Scholar 

  143. Oswald I (1972) Sleep. In: Critchley M, O’Leary JL, Jennett B (eds) Scientific foundation of neurology. Heinemann, London, pp 190–193

    Google Scholar 

  144. Packer RJ, Allen J, Nielsen S, Petito C, Deck M, Jereb B (1983) Pontine glioma: clinical manifestations of meningeal gliomatosis. Ann Neurol 14: 177–182

    Article  PubMed  CAS  Google Scholar 

  145. Packer RJ, Zimmermann RA, Leurson T, et al (1985) Nuclear magnetic resonance in the evaluation of brain stem gliomas of childhood. Neurology 35: 397–401

    PubMed  CAS  Google Scholar 

  146. Pak H, Patel SC, Malik GM, et al (1981) Successful evacuation of a pontine hematoma secondary to rupture of a venous angioma. Surg Neurol 15: 164–167

    Article  PubMed  CAS  Google Scholar 

  147. Panitch HS, Berg BO (1970) Brain stem tumours of childhood and adolescence. Am J Dis Child 119: 465–472

    PubMed  CAS  Google Scholar 

  148. Pau A, Viale ES, Turtas S (1979) Surgical removal of a pontine hematoma associated with a cryptic angioma. Case report. Acta Neurochir (Wien) 50: 299–303

    Article  CAS  Google Scholar 

  149. Pendl G, Vorkapic P (1988) Microsourgery of midbrain lesions. Acta Neurochir (Wien) [Suppl] 42: 130–136

    CAS  Google Scholar 

  150. Pilcher C (1934) Spongioblastoma polare of the pons. Arch Neurol Psychiat 32: 1210–1229

    Google Scholar 

  151. Plum F (1972) Organic disturbances of consciousness. In: Critchley M, O’Leary JL, Jennett B (eds) Scientific foundation of neurology. Heinemann, London, pp 193–201

    Google Scholar 

  152. Plum F, Posner JB (1966) The diagnosis of stupor and coma. Blackwell, Oxford

    Google Scholar 

  153. Pollack IF, Hoffmann HJ, Humphreys RP, Becker L (1993) The long-term outcome after surgical treatment of dorsally exophytic brainstem gliomas. J Neurosurg 78: 859–863

    Article  PubMed  CAS  Google Scholar 

  154. Pool JL (1968) Gliomas in the region of the brain stem. J Neurosurg 29: 164–167

    Article  PubMed  CAS  Google Scholar 

  155. Pouyanne H, Got M, Julien J, et al (1967) Deux cases d’hématomes intraprotubérantiels opérés. Etude critique. Neurochirurgie 13: 738–742

    PubMed  CAS  Google Scholar 

  156. Quisling RG, Quisling SG, Mickle JP (1993) Obex/nucleus gracilis position: its role as a marker for the cervicomedullary junction. Pediatr Neurosurg 19: 143–150

    Article  PubMed  CAS  Google Scholar 

  157. Raimondi AJ (1987) Pediatric neurosurgery. Theoretical principles. Art of surgical techniques. Springer, Berlin Heidelberg New York Tokyo

    Google Scholar 

  158. Ranson SW (1935) The anatomy of the nervous system, 5th Ed. Saunders, Philadelphia

    Google Scholar 

  159. Ranson SW, Magoun HW (1933) The central path of the pupillo constriction reflex in response to light. Arch Neurol Psychiat (Chic) 30: 1193–1202

    Google Scholar 

  160. Redmond JS Jr (1961) The roentgen therapy of pontine gliomas. Am J Roentg 88: 644–648

    Google Scholar 

  161. Reigel DH, Scarff TB, Woodford JE (1979) Biopsy of pediatric brain stem tumours. Childs Brain 5: 329–340

    PubMed  CAS  Google Scholar 

  162. Resche F, Moisan JP, Mantoura J, et al (1993) Haemangioblastoma, haeman-gioblastomatosis, and von Hippel-Lindau disease. In: Symon L et al (eds) Advances and technical standards in neurosurgery, Vol 21. Springer, Wien New York, pp 197–304

    Google Scholar 

  163. Rhoton AL Jr (1979) Microsurgical anatomy of the posterior fossa cranial nerves. Clin Neurosurg 26: 398–462

    PubMed  Google Scholar 

  164. Rosen G, Ghavimi F, Vanucci R, Deck M, Tan C, Murphy ML (1974) Pontine glioma: high-dose methotrexate and leucovorin rescue. JAMA 230: 149–1152

    Article  Google Scholar 

  165. Rossi GF (1964) A hypothesis on the neural basis of consciousness. Acta Neurochir (Wien) 12: 187–197

    Article  CAS  Google Scholar 

  166. Rossi GF, Zanchetti A (1957) The brain stem reticular formation. Arch Ital Biol 95: 199–435

    Google Scholar 

  167. Roth JC, Edvidge AR (1960) Glioblastoma multiforme: a clinical survey. J Neurosurg 17: 736–750

    Article  PubMed  CAS  Google Scholar 

  168. Ruge JA (1993) Mid-brain tumours in children. Crit Rev Neurosurg 3: 66–71

    Google Scholar 

  169. Russell B, Rengachary SS, McGregor D (1986) Primary pontine hematoma presenting as a cerebello-pontine angle mass. Neurosurgery 19: 129–133

    Article  PubMed  CAS  Google Scholar 

  170. Russell DS, Rubinstein LJ (1959) Pathology of tumours of the nervous system. Edward Arnold, London

    Google Scholar 

  171. Russell DS, Rubinstein LJ (1989) Pathology of tumours of the nervous system, 5th Ed. Williams and Wilkins, Baltimore, pp 149–152

    Google Scholar 

  172. Sanford RA, Smith RA (1986) Hemangioblastoma of the cervicomedullary junction. J Neurosurg 64: 317–321

    Article  PubMed  CAS  Google Scholar 

  173. Sano K (1983) Spontaneous brain stem hematoma. Neurosurg Rev 8: 71–77

    Article  Google Scholar 

  174. Sano K (1987) Pineal region and posterior third ventricular tumours: a surgical overview. In: Appuzzo MLJ (ed) Surgery of the third ventricle. William and Wilkins, Los Angeles, pp 663–683

    Google Scholar 

  175. Sano K, Ochiai C (1980) Brain stem haematomas. Clinical aspects with reference to indications for treatment. In: Pia HW, Langmaid C, Zierski J (eds) Spontaneous intracerebral haematomas. Advances in diagnosis and therapy. Springer, Berlin Heidelberg New York, pp 366–371

    Google Scholar 

  176. Sarkari NBS, Bickerstaff ER (1969) Relapses and remissions in brain stem tumours. BMJ 2: 21–23

    Article  PubMed  CAS  Google Scholar 

  177. Schain RJ, Wilson G (1971) Brain-stem encephalitis with radiographic evidence of medullary enlargement. Neurology 21: 537–539

    PubMed  CAS  Google Scholar 

  178. Scott BB, Seeger JF, Schneider RC (1973) Successful evacuation of a pontine hematoma secondary to rupture of a pathologically diagnosed “cryptic” vascular malformation. Case report. J Neurosurg 39: 104–108

    Article  PubMed  CAS  Google Scholar 

  179. Sheline GE (1975) Radiation therapy of tumours of the central nervous system in childhood. Cancer 35: 957–964

    Article  PubMed  CAS  Google Scholar 

  180. Sjöquist O (1938) Studies on the pain conduction in the trigeminal nerve. Acta Psychiat Scand [Suppl] 17: 1–139

    Google Scholar 

  181. Soffer D, Sahar A (1982) Cystic glioma of the brain stem with prolonged survival. Neurosurgery 10: 499–502

    Article  PubMed  CAS  Google Scholar 

  182. Spague JM, Meickle TH (1965) The role of the superior colliculus in visually guided behavior. Exp Neurol 11: 115–146

    Article  Google Scholar 

  183. Spiegel EA (1953) Mesencephalotomy in treatment of intractable facial pain. Arch Neurol Psychiat 69: 1–13

    CAS  Google Scholar 

  184. Stein BM (1971) The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35: 197–202

    Article  PubMed  CAS  Google Scholar 

  185. Stein BM (1982) Supracerebellar approach for pineal neoplasms. In: Schmidek H, Sweet W (eds) Operative neurosurgical techniques, Vol 1. Grune and Stratton, New York, pp 599–607

    Google Scholar 

  186. Stein BM (1987) Infratentorial supracerebellar approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams and Wilkins, Los Angeles, pp 570–590

    Google Scholar 

  187. Strange P, Wohlert L (1982) Primary brain stem tumours. Acta Neurochir (Wien) 62: 219–232

    Article  CAS  Google Scholar 

  188. Strauss C, Romstöck J, Nimski C, Fahlbusch R (1993) Intraoperative indentification of motor areas of the rhomboid fossa using direct stimulation. J Neurosurg 79: 393–399

    Article  PubMed  CAS  Google Scholar 

  189. Stroink AR, Hoffman HJ, Hedrick EB, Humphreys RP (1986) Diagnosis and management of pediatric brain-stem gliomas. J Neurosurg 65: 745–750

    Article  PubMed  CAS  Google Scholar 

  190. Stroink AR, Hoffman HJ, Hendrick EB, et al (1987) Transependymal benign dorsally exophytic brain stem gliomas of childhood: diagnosis and treatment recommendations. Neurosurgery 20: 439–444

    Article  PubMed  CAS  Google Scholar 

  191. Suzuki J, Katakura R, Mori T (1984) Interhemispheric approach through the lamina terminalis to tumours of the anterior part of the third ventricle. Surg Neurol 22: 157–163

    Article  PubMed  CAS  Google Scholar 

  192. Symon L, Jackowski A, Bills D (1991) Surgical treatment of pontomedullary cavernomas. Br J Neurosurg 5: 339–347

    Article  PubMed  CAS  Google Scholar 

  193. Tomita T (1986) Surgical management of cerebellar peduncle lesions in children. Neurosurgery 18: 568–575

    Article  PubMed  CAS  Google Scholar 

  194. Turazzi S, Bricolo A (1977) Acute pontine syndromes following head injury. Lancet 2: 62–64

    Article  PubMed  CAS  Google Scholar 

  195. Umansky F, Toledo E, Cohen M, et al (1983) Successful removal of an acute brain stem hematoma in a young child. Childs Brain 10: 350–354

    PubMed  CAS  Google Scholar 

  196. Vandertop WP, Hoffman HJ, Drake JM, Humphreys RP, Rutka JT, Armstrong DC, Becker LE (1992) Focal midbrain tumours in children. Neurosurgery 31: 186–194

    Article  PubMed  CAS  Google Scholar 

  197. VanGehuchten P (1937) Le mécanisme de la mort dans certains cas de tumeurs cérébrales. L’Encéphale 2: 113–127

    Google Scholar 

  198. Vaquero J, Areitio E, Leunda G, et al (1980) Hematoma of the pons. Surg Neurol 14: 115–118

    PubMed  CAS  Google Scholar 

  199. Villani R, Gaini SM, Tomei G (1975) Follow up study of brain stem tumours in children. Childs Brain 1: 126–135

    PubMed  CAS  Google Scholar 

  200. Walker AE (1942) Relief of pain by mesencephalic tractotomy. Arch Neurol Psychiat 48: 865–883

    Google Scholar 

  201. Weaver EN Jr, Coulon RA Jr (1979) Excision of a brainstem epidermoid cyst: case report. J Neurosurg 51: 254–257

    Article  PubMed  Google Scholar 

  202. Weil SM, Tew JM Jr (1990) Surgical management of brain stem vascular malformations. Acta Neurochir (Wien) 105: 14–23

    Article  CAS  Google Scholar 

  203. Weisberg LA, Nice C, Katz M (1978) Cerebral computed tomography: A text-atlas. Saunders, Philadelphia, pp 123–127

    Google Scholar 

  204. White HH (1963) Brain stem tumours occurring in adults. Neurology (Minn) 13: 292–300

    CAS  Google Scholar 

  205. White JC, Sweet WH (1969) Pain and the neurosurgeon. A forty-year experience. Thomas, Springfield

    Google Scholar 

  206. Williams PL et al (1989) Gray’s anatomy, 37th Ed. Churchill, Edinburgh Livingstone

    Google Scholar 

  207. Yasargil MG, Teddy PJ, Roth P (1985) Selective amygdalo hippocampectomy. Operative anatomy and surgical technique. In: Symon L et al (eds) Advances and technical standards in neurosurgery, Vol 12. Springer, Wien New York, pp 93–123

    Google Scholar 

  208. Yoshimoto T, Suzuki J (1986) Radical surgery on cavernous angioma of the brainstem. Surg Neurol 26: 72–78

    Article  PubMed  CAS  Google Scholar 

  209. Zimmermann RS, Spetzler RF, Lee SK, et al (1991) Cavernous malformations of the brain stem. J Neurosurg 75: 32–39

    Article  Google Scholar 

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Bricolo, A., Turazzi, S. (1995). Surgery for Gliomas and Other Mass Lesions of the Brainstem. In: Symon, L., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 22. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6898-1_5

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