Multiple gliomas [Neurosurgery Wiki]

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====== Multiple gliomas ======

Some of the following terms are inconsistently used interchangeably: “[[multicentric glioma]],” “[[multifocal glioma]],” and “[[multiple glioma]]”.
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Discussion of multiple [[glioma]]tous masses has to acknowledge the concept that [[astrocytoma]] is a [[multifocal]] disease, not a focal one. Some terms are probably artificial. The term [[gliomatosis cerebri]] has been dropped by the [[World Health Organization Classification of Tumors of the Central Nervous System 2016]]. Now, widespread [[brain invasion]] involving ≥ 3 [[lobe]]s, frequently with bilateral involvement and often with [[posterior fossa]] extension, is considered a special pattern of spread within several diffuse [[glioma]] subtypes.

Settings in which multiple gliomatous masses are encountered:

conventional glioma that has spread by one of the mechanisms previously described multiple primary gliomas: some of the following terms are inconsistently used interchangeably: “[[multicentric glioma]],” “[[multifocal glioma]],” and “[[multiple glioma]].” The reported range of occurrence is 2–20% of gliomas
((Barnard RO, Geddes JF. The Incidence of Multifocal Cerebral Gliomas: A Histological Study of Large Hemisphere Sections. Cancer. 1987; 60:1519–1531))
((van Tassel P, Lee Y-Y, Bruner JM. Synchronous and Metachronous Malignant Gliomas: CT Findings. AJNR. 1988; 9:725–732))
(lower end of range ≈ 2–4% is probably more accurate; the higher end of the range is probably accounted for by infiltrative extension
((Harsh GR, Wilson CB, Youmans JR. Neuroepithelial
Tumors of the Adult Brain. In: Neurological
Surgery. 3rd ed. Philadelphia: W. B. Saunders;1990:3040–3136))

a) commonly associated with neurofibromatosis and tuberous sclerosis

b) rarely associated with multiple sclerosis and progressive multifocal leukoencephalopathy meningeal gliomatosis: dissemination of glioma throughout the CSF, similar to carcinomatous meningitis. Occurs in up to 20% of autopsies on patients with high-grade gliomas. May present with cranial neuropathies, radiculopathies, myelopathy, dementia, and/or communicating hydrocephalus

In a series of 25 patients with multicentric glioma,
((Salvati M, Caroli E, Orlando ER, et al. Multicentric
glioma: our experience in 25 patients and critical review of the literature. Neurosurg Rev. 2003; 26: 275–279))
glioblastoma was the most common pathology (48%), followed by anaplastic astrocytoma (20%), and glioblastoma with simultaneous AA (20%).

Rarely multiple gliomas may be undetectable on CT and will be misdiagnosed as [[pseudotumor cerebri]].

▶ Treatment considerations for multiple gliomas. There is little data available. In a nonrandomized study of 25 patients with multifocal glioma
((Salvati M, Caroli E, Orlando ER, et al. Multicentric
glioma: our experience in 25 patients and critical review of the literature. Neurosurg Rev. 2003; 26: 275–279)) 
the 16 patients who underwent debulking did better than the 9 who did not. However, there was significant selection bias in choosing patients suitable for craniotomy.
A biopsy is generally required/recommended to confirm the diagnosis.
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Multiple [[glioma]]s were first observed by Virchow in 1864 and Bradley in 1880.

In their seminal paper published in 1962, Batzdorf and Malamud characterized the modes of growth in gliomas by establishing criteria to distinguish multiple and [[multicentric glioma]]s 

Namely, multiple gliomas disseminates along established CNS routes, such as [[white matter tract]]s, [[cerebrospinal fluid]] (CSF), or local invasion. 

see [[Multicentric glioma]]