Brainstem Tumor

Brainstem tumors are mainly gliomas, but hemangioblastoma or metastatic tumors may also occur. Brainstem gliomas mainly affect children, but young adults may also be affected; middle-aged/elderly patients are rare. Based on MRI, Epstein divides brainstem tumors into three types: Type I — focal tumor, relatively well-demarcated, diameter <2 cm, or exophytic growth dorsally; Type II — tumor at cervicomedullary junction or exophytic, often involving lower 2/3 of medulla and ventral spinal cord; Type III — diffuse.

Common Symptoms

Facial numbness; internal bleeding; Romberg sign; raised intracranial pressure; nausea; hyperreflexia; diplopia; dysarthria

Causes and Pathogenesis

Emotional factors (55%): Cause is not yet clear. Gliomas have the highest incidence among brainstem tumors (~40.49%). TCM holds that this disease arises from fright or great anger, or prolonged grief/melancholy, causing disordered qi/blood flow, reduced resistance, and pathogenic factors exploiting the void to produce cancer. Pathogenesis: Brainstem tumors mostly lie in the pons, growing expansively and extending up/down along nerve-fiber tracts. Astrocytomas can occur anywhere in the brainstem, mostly infiltrative; ependymomas mostly lie at the bottom of the 4th ventricle; hemangioblastomas grow expansively and may invade dorsal medulla; cavernous hemangiomas mostly lie in the pons. Grossly the brainstem is symmetrically or asymmetrically enlarged, grey-white or pink on surface. Fast-growing highly malignant tumors show hemorrhage, necrosis, even cystic change with yellow fluid. Microscopy shows pilocytic astrocytomas with bipolar/unipolar astrocytes, occasionally multinucleate giant cells. 1. Diffuse type (~67%): no boundary between tumor and normal brainstem neural tissue; normal neurons and axons exist among tumor cells; pathologic type is usually various-grade astrocytoma (I-IV). 2. Expansive type (~22%): well-demarcated tumor with a dense layer of neoplastic astrocytic axons between tumor and surrounding brainstem (tumor capsule); pathologic type is mostly pilocytic astrocytoma (Grade I); ~40% contain vascular hamartoma called angiocentric astrocytoma. 3. Infiltrative type (~11%): grossly appears to have a boundary, but tumor cells actually infiltrate surrounding brainstem neural tissue, which is completely destroyed; pathologic type is mostly primitive neuroectodermal tumor.

Treatment

Surgery, radiotherapy, drug therapy, supportive therapy

Preventive Measures

No special preventive measures, but pay attention in daily life: 1. Food hygiene — avoid benzo(a)pyrene, nitrosamines and other carcinogens. 2. Personal hygiene, exercise to build resistance and prevent viral infection. 3. Avoid brain trauma; if it occurs, treat promptly; patients with intracranial tumors should not have further children. 4. Eat more yellow-green vegetables and fruits: carrots, pumpkin, tomato, lettuce, bok choy, spinach, jujube, banana, apple, mango.

Department to Visit

It is recommended to visit the Neurosurgery department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.