Brainstem glioma classification [Neurosurgery Wiki]

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====== Brainstem glioma classification ======

Brainstem gliomas are classified based on several criteria, including their location, histological type, and molecular characteristics. Here’s a detailed overview of the classification:

1. Location-Based Classification
Diffuse Intrinsic Pontine Glioma (DIPG): The most common and aggressive type, primarily occurring in the pons. It often presents in children and has a poor prognosis.
Focal Brainstem Gliomas: These tumors are localized and may include:
Exophytic Tumors: Tumors that grow outward from the brainstem.
Circumscribed Tumors: Well-defined tumors that do not infiltrate surrounding brain tissue.
2. Histological Classification
Astrocytomas: The most common type of brainstem glioma, categorized into:
Pilocytic Astrocytoma: Typically a low-grade tumor that may occur in the brainstem.
Fibrillary Astrocytoma: Often classified as a grade II tumor.
Anaplastic Astrocytoma: A higher-grade (grade III) tumor with a more aggressive behavior.
Glioblastoma Multiforme (GBM): The most aggressive type (grade IV) that can occur in the brainstem.
Ependymomas: These can also occur in the brainstem and arise from ependymal cells lining the ventricles.
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3. Molecular Classification
Recent advances have allowed for a molecular classification based on genetic alterations:
H3 K27M Mutant Gliomas: A specific mutation that is common in DIPGs and associated with poor prognosis.
IDH Mutant Gliomas: Less common in pediatric brainstem gliomas but may occur.
Histone Mutations: Alterations in histones can also help classify gliomas based on molecular characteristics.
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4. Age-Based Considerations
[[Pediatric Brainstem Glioma]]s: Typically include [[DIPG]] and pilocytic astrocytomas.

[[Adult Brainstem Glioma]]s: Less common but may present as high-grade gliomas or secondary tumors.

Summary of Common Types
Diffuse Intrinsic Pontine Glioma (DIPG): Aggressive, infiltrative tumor in the pons, primarily in children.
Pilocytic Astrocytoma: Often found in younger patients, can be localized in the brainstem.
Anaplastic Astrocytoma: More aggressive, may present in the brainstem.
Glioblastoma Multiforme: Rare but possible, highly aggressive brainstem tumor.
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[[Adult brainstem glioma]]

[[Diffuse intrinsic pontine glioma]].

[[Diffuse high-grade brainstem glioma]]

[[Midbrain glioma]].

[[H3K27M-mutant brainstem glioma]]

[[Brainstem high grade glioma]].