Diffuse Midline Glioma (DMG)

A rapidly progressive brain tumor that develops in midline structures of the brain in children, particularly in the brainstem.

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Neuro-Oncology: Brain Tumors

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1Overview

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What is this Condition?

Diffuse midline glioma (DMG) is a rapidly progressive brain tumor that develops in midline structures of the brain (most commonly the brainstem, as well as the thalamus and spinal cord), predominantly seen in children. It was previously referred to as 'brainstem tumor' (DIPG). The tumor grows by infiltrating healthy tissue and is located in regions that control vital brain functions, making surgical removal impossible. The mainstay of treatment is radiation therapy, which can alleviate symptoms for a period of time. Although the disease follows a challenging course, recently a targeted drug has been approved for the first time in recurrent cases, and research is progressing rapidly. The disease should be managed by a pediatric neuro-oncology team, and psychological support should be provided to families.

Symptoms

Double vision, facial asymmetry (cranial nerve involvement)

Difficulty swallowing and voice changes

Weakness on one side or throughout the entire body

Unsteady gait, coordination disorder, clumsiness

Rapidly progressive symptoms (usually within several months)

Changes in consciousness and respiration at advanced stages

Diagnosis Methods

Contrast-enhanced brain MRI is the fundamental diagnostic method. The typical DMG appearance in the brainstem is often sufficient for diagnosis and biopsy is not always necessary. In atypical presentations or when determining the tumor's genetic characteristics for targeted treatment, a small tissue sample (stereotactic biopsy) may be obtained; this sample is examined for a genetic mutation called H3 K27M.

Treatment Methods

The mainstay of treatment is radiation therapy, which alleviates symptoms in most children for several months. Due to the tumor's infiltrative nature and growth in vital regions, surgical resection is not appropriate; surgery is limited to tissue sampling for diagnosis or drainage of fluid accumulation. In recurrent disease, a recently approved targeted drug and various clinical trial treatments may be considered. Symptomatic supportive care is also an important part of the treatment plan.

Radiation therapy (standard first-line treatment, alleviates symptoms)

Stereotactic biopsy for diagnosis or genetic analysis (if needed)

Targeted drugs and clinical trial treatments in recurrent disease

Symptomatic supportive care and psychological support

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Endoscopic Tumor Biopsy

Endoscopic Tumor Biopsy procedure

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Glial tümörler, internal dekompresyon, mikrocerrahi ile

Glial tümörler, internal dekompresyon, mikrocerrahi ile procedure

Open treatment detail

Posterior fossa tümörleri

Posterior fossa tümörleri procedure

Open treatment detail

Stereotaktik radyocerrahi (SRC) - Gamma Knife, Cyberknife

Stereotaktik radyocerrahi (SRC) - Gamma Knife, Cyberknife procedure

Open treatment detail

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Chiarelli PA, et al. Brainstem Tumors. In: Di Rocco C, Pang D, Rutka JT, eds. Textbook of Pediatric Neurosurgery. Springer; 2020.
Osborn AG, Hedlund GL, Salzman KL. Osborn's Brain: Imaging, Pathology, and Anatomy. 2nd ed. Elsevier; 2018.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Diffuse Midline Glioma (DMG)

Neuro-Oncology: Brain Tumors

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Endoscopic Tumor Biopsy

Glial tümörler, internal dekompresyon, mikrocerrahi ile

Posterior fossa tümörleri

Stereotaktik radyocerrahi (SRC) - Gamma Knife, Cyberknife

References

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Related Treatments

Endoscopic Tumor Biopsy

Glial tümörler, internal dekompresyon, mikrocerrahi ile

Posterior fossa tümörleri

Stereotaktik radyocerrahi (SRC) - Gamma Knife, Cyberknife

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