TITLE:
Rare Adult Spinal Diffuse Midline Glioma with Craniospinal Progression: A Case-Based Review
AUTHORS:
Mariana Chibante Pedro, João Nabais, Henrique Cabral
KEYWORDS:
Diffuse Midline Gliomas, Intramedullary Spinal Cord Glioma, Spinal Surgery, Adjuvant Treatment, Palliative Care
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.16 No.3,
July
9,
2026
ABSTRACT: Introduction: Spinal gliomas account for approximately 10% of all gliomas of the central nervous system. Ependymomas and pilocytic astrocytomas are the most prevalent subtypes, whereas diffuse spinal gliomas are relatively rare. The H3K27 mutation is a molecular marker of malignancy. Case Description: We present the clinical case of a 29-year-old female patient with no significant past medical history. In 2021, during pregnancy, she developed lumbar pain with radiation to the left lower limb. This was initially presumed to be pregnancy related and treated symptomatically. Postpartum, the pain worsened, and motor deficit of the left lower limb appeared—asymmetric spastic paraparesis, predominantly on the left, with asymmetric hyperreflexia and sustained clonus in the limb. A cervical-thoracic spinal MRI revealed a large tubular intramedullary lesion extending from C6 to T10. A surgical biopsy was performed, and histopathological analysis revealed a diffuse midline glioma with H3K27M mutation. Initial treatment included radiotherapy followed by chemotherapy. In February 2024, the patient presented with worsening motor function, progressing to paraplegia. No intracranial dissemination was noted at that time. In 2025, a new right cerebellar metastasis was identified. Initially proposed for radiotherapy but was unable to commence due to rapid clinical deterioration. This case highlights an unusually prolonged survival for this lesion subtype, suggesting that further study into prognostic factors and treatment responses is warranted.