High-grade gliomas: Neuraxis dissemination pattern and prognosis

The incidence of symptomatic glioma neuraxis dissemination has been increasing. In this study we evaluated the clinical incidence and characteristics of dissemination and effects on patient outcome. Patients treated for 229 primary rnalignant gliomas between 1993 and 2004 were followed until December 31, 2004. Brain magnetic resonance imaing of all 9 patients was obtained every 3 and 6 months. Signs and symptoms of neuraxis dissemination were evaluated at monthly outpatient examinations. A spinal magnetic resonance was performed if there were any symptoms indicating spinal dissemination. The incidence of neuraxis dissemination was 3% (7/229). There was I patient with anaplastic oligodendroglioma and 6 patients with glioblastomas. The patient age ranged from 25 to 57 years (mean 36.5 y). The location of the tumors was frontal in 3 cases, temporal in 3 cases, and at the thalamus in I case. The pathologic labeling index (MIBI) was from 8% to 40%. Clinical manifestations included: headache in 4 cases, back pain in 4 cases, intractable vomiting in 3 cases, and gait disturbance in I case. The mean survival time for patients was 2.5 months. In conclusion, patients with neuraxis dissemination tended to be younger than glioma patients without dissemination. Because of the short survival time, patients deserve optimal pain management and dedicated palliative care.