Perspective on the Influence of Biopsy on the Survival of Pediatric Patients with Diffuse Brainstem Gliomas: A Literature Review

Introduction Diffuse brainstem gliomas (DBG) represent the most common subtype of pediatric brainstem tumors, characterized by a systematically grim prognosis with a median survival rate of 10% two years post-diagnosis. Unlike other brain tumors, diffuse brainstem gliomas have traditionally relied on cranial magnetic resonance imaging (MRI) as a sufficient diagnostic tool, rendering surgical biopsies deemed unnecessary. Objectives To conduct a literature review aiming to assess whether the performance of surgical biopsies has influenced the survival outcomes of children with diffuse brainstem gliomas. Materials and Methods A comprehensive literature review was conducted using electronic databases PubMed, Embase, and LILACS. The search terms included "glioma" or "diffuse glioma" in conjunction with "pediatric" or "childhood," combined with "biopsy" or "stereotactic," and further combined with "brainstem," "pons," "pontine," or "mesencephalon," along with "survival." The searches were limited to studies involving pediatric patients (age <18 years) published between 1980 and 2021. Results The analysis of the presented data revealed morbidity ranging from 0% to 33.3% and mortality from 0% to 2.2%. Transfrontal access was predominantly favored by most authors, followed by transcerebellar approaches. The rate of inconclusive biopsies varied from 0% to 30%. Conclusion Given the infiltrative nature of diffuse brainstem gliomas; surgical resection is generally deemed impractical. Radiation therapy remains the standard treatment, providing a marginal survival benefit of similar to 3 months. There is currently no established chemotherapy protocol for this pathology.