Brainstem Glioma

  • Etiology: Heterogeneous group of tumors
  • Imaging:
    — Anterior to fourth ventricle
    — Can be tectal or ventral pons or dorsal pons or medulla
    — Usually infiltrative
    — Can be exophytic and encase basilar artery
    — Occasionally cystic
    — Irregular enhancement (50%)
  • Imaging CT: Enlarged hypodense pons
  • DDX: Granuloma, rhomboencephalitis, infarction, cryptic vascular malformation, demyelination, metastasis, radiation effect
  • Complications:
  • Treatment: Difficult to treat given location so is non-resectable
  • Clinical: May cause cranial nerve palsy

Radiology Cases of Brainstem Glioma

MRI of brainstem glioma
Sagittal T1 MRI without contrast of the brain (above left) shows a large mass expanding the entire brainstem. Axial T2 (above right) and axial FLAIR (below left) MRI show the mass to be somewhat heterogenous and the mass has multiple foci of enhancement on the axial T1 MRI with contrast (below right).

Radiology Cases of Diffuse Midline Glioma

MRI of diffuse midline glioma
Axial FLAIR MRI without contrast of the brain (above left) shows the pons to be enlarged and to have increased signal intensity throughout. There is also increased signal intensity in the medial aspect of the left temporal lobe. Going upwards in the brain (above right and below) the increased signal intensity is seen in the midbrain and in the left basal ganglia and thalamus.