Objective: To explore the neuroimaging diagnosis and therapeutic efficacy of different surgical methods of gliomatosis cerebri.
Methods: 26 cases of gliomatosis cerebri at our department between September 2008 and September 2013 were retrospectively analyzed. Preoperative cranial computed tomography (CT), magnetic resonance imaging (MRI) and other multimodal imaging scans were performed. The procedures included stereotactic brain biopsy (n = 11) and large craniotomy lobotomy (n = 15). Whole brain radiotherapy and/or temozolomide therapy was performed postoperatively according to the malignancy of tumors. Follow-ups were conducted to analyze the survival differences between stereotactic brain biopsy and large craniotomy lobotomy groups.
Results: According to the different features of multimodal imaging, gliomatosis cerebri could be divided into two types: (1) type I(n = 19) showed a diffuse infiltrating lesion infringing multiple brain lobes or regions with central corpus callosum but without obvious enhancement; (2) type II (n = 7) appeared as sporadic or tuberous enhancement in addition to the features of type I. Pathological diagnosis: pilocytic astrocytoma (n = 2), diffuse astrocytoma (n = 13), oligodendroglial tumors (n = 3), oligoastrocytoma (n = 1), anaplastic astrocytoma (n = 5) and glioblastoma (n = 2). The degree of malignancy was a prognostic factor for postoperative survival in patients with gliomatosis cerebri. The mean survival time (MST) of large craniotomy lobotomy group (23 ± 7) was significantly longer than that of stereotactic brain biopsy group (13 ± 3) (P < 0.05).
Conclusion: Gliomatosis cerebri is a primary brain glial tumor with diffuse infiltrative growth but retaining the general structure of central nervous system. Multimodal imaging studies plus pathological examination yield a definitive diagnosis. Comprehensive treatment of operation plus chemo- or radio-therapy can prolong postoperative MST.