Brainstem Tumors

Brainstem lesions comprise about 1.5% of all primary brain tumors and encompass a diverse spectrum of neoplasms and vascular abnormalities, with gliomas and cavernomas being predominant. These lesions often manifest with symptomatic presentations due to compression or infiltration of vital neural structures, leading to acute symptom onset or worsening neurological deficits. The majority of brainstem lesions are not amenable to complete or gross total resection; however, significant advances in microsurgical techniques and the concept of “safe entry zones” have significantly reduced morbidity associated with brainstem surgery. In addition to surgery, radiotherapy remains the cornerstone of the treatment of brainstem tumors, often supplemented with chemotherapy in high-grade lesions, while stereotactic radiosurgery is emerging as a valuable option. This chapter provides insights into the complex landscape of brainstem lesions, analyzing the outcomes of 1085 adult and pediatric patients harboring brainstem gliomas (BSGs) in 39 studies and 2123 patients with brainstem cavernomas (BSCs) in 17 works. Additionally, we here provide the institutional experience of multimodal treatment of 11 BSGs and 16 BSCs. Through an examination of clinical and neuroradiological presentations, surgical approaches, and adjuvant treatment modalities, this review aims to enhance understanding and guide tailored management strategies for patients with brainstem pathology.