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2019, Número 1

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Rev Neurol Neurocir Psiquiat 2019; 47 (1)


Gliomas de tallo cerebral; generalidades de diagnóstico, tratamiento y pronóstico

Peiro OP, Alentorn A, Hernández-Hernández A, Reyes-Moreno I, Gutiérrez AGA, González-Aguilar A

Idioma: Español
Referencias bibliográficas: 73
Paginas: 5-15
Archivo PDF: 365.46 Kb.


RESUMEN

Los gliomas de tallo cerebral son poco comunes, en los adultos representan 1-2% de los gliomas intracraneales. En los adultos predomina un fenotipo de bajo grado, una característica que probablemente explica su mejor pronóstico en comparación con los niños. Debido a que la biopsia se realiza con poca frecuencia, se ha propuesto una clasificación basada en los aspectos radiológicos en resonancia magnética para establecer estrategias de tratamiento y determinar el resultado: 1. Intrínseco difuso “de bajo grado”, 2. Glioma de tallo “maligno” con reforzamiento focal (GTMRF), 3. Exofítico y 4. Gliomas focales tectales. A pesar de los importantes avances en neurorradiología tales como espectroscopia de resonancia magnética multivoxel, tensor de difusión y perfusión, una clasificación radiológica pura sigue siendo imperfecta en ausencia de un diagnóstico histológico. Mientras que la biopsia puede ser razonablemente evitada en las formas difusas, es necesaria una prueba histológica en muchas lesiones del tallo cerebral cuando se evidencian lesiones captantes de contraste debido a la gran variedad de diagnósticos diferenciales en los adultos. La radioterapia es el tratamiento estándar para los gliomas difusos intrínsecos de “bajo grado” de tallo cerebral en los adultos (la media de supervivencia es de cinco años). En los gliomas “malignos” de tallo con reforzamiento focal, la radioterapia es el tratamiento estándar y el posible beneficio de la radioterapia y la quimioterapia combinada (temozolamida u otros agentes) no se ha evaluado a fondo en adultos. El papel de las terapias con antiangiogénicos en gliomas de tallo cerebral está todavía por definirse. Una mejor comprensión de la biología de estos tumores es esencial para identificar subgrupos homogéneos y mejorar la terapia.


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