Glioma

Glioma is a broad name for tumors that start in the glial (supporting) cells of the brain and spinal cord. Gliomas are the most common group of brain tumors in children.

Types of glioma

• Astrocytoma — from astrocytes; most common in children
• Brainstem glioma — including diffuse midline glioma (DIPG), a very serious tumor
• Ependymoma — from cells lining the fluid spaces of the brain and spinal cord
• Oligodendroglioma — rare in children
• Optic pathway glioma — along the nerves of vision, often linked to NF1
• Mixed gliomas — with more than one type of cell

Symptoms

• Headaches, nausea and vomiting
• Seizures
• Vision problems or abnormal eye movements
• Weakness, clumsiness or balance problems
• Changes in behaviour, mood or school performance
• Hormone problems or abnormal growth (tumors near the pituitary)

Risk factors

Neurofibromatosis types 1 and 2, tuberous sclerosis, Li-Fraumeni syndrome and previous radiation to the head.

Grading

Low-grade gliomas (grade 1–2) grow slowly and have an excellent long-term survival. High-grade gliomas (grade 3–4) grow quickly and need intensive treatment.

Prognosis

Most children with low-grade glioma live long lives, although some need several lines of treatment. The outlook for high-grade glioma is more serious, and clinical trials are important.

Diagnosis combines imaging, tissue analysis and molecular testing.

Physical exam and medical history

Including questions about growth, puberty and family history.

Neurological exam

Tests vision, hearing, balance, coordination, strength and reflexes.

Computed tomography (CT) scan

A quick scan, often used first in an emergency.

Magnetic resonance imaging (MRI)

The key scan of the brain and spine for diagnosis, planning surgery and follow-up.

Biopsy

Tissue removed at surgery, or by a needle biopsy, is examined by a neuropathologist. Some tumors with typical appearance (e.g. DIPG, optic glioma with NF1) may be diagnosed on MRI alone.

Lumbar puncture

Used for some tumor types to check the spinal fluid.

Molecular testing

Identifies changes such as BRAF fusion or V600E, H3 K27M, IDH and NTRK fusions that guide targeted therapy.

Treatment is tailored to the type, grade, location and molecular profile of the glioma.

Low-grade vs high-grade glioma

Low-grade gliomas are often treated with surgery, chemotherapy or targeted therapy, aiming to control the tumor while protecting development. High-grade gliomas usually need surgery followed by radiation and chemotherapy.

Surgery

Maximal safe removal is the first step whenever the tumor is in an accessible area.

Chemotherapy

Weekly or monthly chemotherapy (for example carboplatin and vincristine, or vinblastine) for low-grade tumors that cannot be removed.

Radiotherapy

Focused radiation for high-grade gliomas and for progressive low-grade gliomas in older children.

Targeted therapy

BRAF/MEK inhibitors, NTRK inhibitors and other targeted drugs for tumors with matching changes.

Bone marrow / stem cell transplant with high-dose chemotherapy

Considered in selected high-grade or recurrent tumors.

Follow-up care and side effects

Regular MRI, vision, hormone and neuro-psychological follow-up, and rehabilitation to support daily life and learning.

Our pediatric neuro-oncology team plans glioma treatment with neurosurgery, radiation oncology and pathology.