ИСТИНА

Objectives: Such issues as the optimal volume of tumor resection, the most appropriate surgical approaches for tumor removal remain the topic for discussion. We aimed to answer all these questions. Background: Traditionally, the BsT divided into focal tumors, predominantly pilocitic astrocytomas, in which surgical treatment strictly recommended; and diffuse (astrocytomas II-IV), in which treatment is limited to adjuvant therapy. In fact, there is a wide range of brainstem neoplasms that are difficult to classify according to generally accepted classification. These BsTu demonstrate MRI signs of diffuse as well as focal lesion. In such cases, indications to surgery remain controversial. Methods: 278 patients with BsTs operated in NSI in the period from 2005 to 2018. 45% were children, 55% were adults. In both age categories, the gender distribution was approximately equal: 48% - women, 52% - men. The clinical and MRI features, course of operation, the results of surgical treatment were analyzed. Results: the indications for surgery were MRI - demarcated tumors, as well as tumors of the "intermediate" group. The aim of surgery was the maximum radicality of tumor removal, and at the same time the safety of functional structures. In endophytic tumors of the medulla oblongata and pons, we preferred lateral approaches, in which the tectum of the Bs remained intact. According to biopsy 67% were PA, 33% - gliomas II-IV. The outcomes of surgical treatment differed strictly in children and adults. In children, regress of neurological symptoms after surgery was observed in 79% and an increase only in 14%; while in adults, 33% improved, an increase of symptoms occurred in 43%. The revealed difference in surgical outcomes in children and adults age explained by the different ratio of benign and malignant tumors in these age groups. Conclusions: BsTu are a heterogeneous group. Surgery in BsTu indicated in all cases except classical DIPG.