10259-NQPC-9 CONTROVERSY ON INVASIVE AIRWAY MANAGEMENT IN PATIENTS WITH BRAIN STEM MALIGNANT GLIOMA.

Abstract INTRODUCTION The prognosis for patients with malignant gliomas of the brainstem is poor. As the tumor progresses into the medulla oblongata, the lower cranial nerves are affected, resulting in dysphagia and eventually respiratory paralysis. On the other hand, higher cerebral function is often preserved, making it a palliative medical issue whether to perform invasive procedures to secure the airway. We report here three characteristic cases treated at our hospital. CASE 1 A-60-year-old male patient with diffuse midline glioma of the medulla oblongata was admitted to our hospital for radiation therapy and concomitant temozolomide. His consciousness level was clear, but dysphagia was noted. Although he was at risk for aspiration and choking, he did not wish to undergo surgery to prevent aspiration. After treatment was started, he died of choking. CASE 2 A-50-year-old male patient with recurrent astrocytoma in the brainstem was admitted for bevacizumab monotherapy. Despite the treatment, his dysphagia gradually worsened, and he developed respiratory failure due to aspiration pneumonia, resulting in tracheal intubation. Subsequently, he underwent glottis closure, and as a result, he lost his speech but recurrence of aspiration pneumonia and choking were prevented. CASE 3 A-50-year-old male patient with cerebellar glioma invading brainstem was admitted due to aspiration pneumonia. He was disoriented and required heavy care. He did not wish to undergo surgery to prevent aspiration, but with antimicrobial therapy and frequent oral suctioning, his aspiration pneumonia was cured. DISCUSSION Although invasive procedures are generally avoided in terminal-stage cancer patients, anti-aspiration procedures such as tracheostomy and glottis closure may be considered for the conscious patients with malignant glioma in the brainstem. These procedures might be an option at the end of life to avoid painful death due to choking and to prevent deterioration of the patient's condition due to repeated aspiration pneumonia.