The role of surgery in the intrinsic brainstem glioma is limited to the occasional necessity for permanent CSF diversion. Biopsy has not proven to add important information which will alter therapy and, given the high potential for morbidity, is not recommended. On the other hand, focal lesions of the brainstem can often be approached surgically (Fig. 28.7). In most cases, a subtotal resection is all that can be safely accomplished. Even in the absence of postoperative adjuvant treatment, generous central debulking of focal brainstem tumors can provide significant disease control and surgical success should be based on neurologic outcome from surgery, rather than the amount of tumor resected. Exophytic tumors of the brainstem should be approached like other fourth-ventricular tumors until the fourth ventricle is free of tumor. A decision to enter the brainstem should only be made after confirmation of low-grade histology and then surgery should proceed as described above for focal brainstem tumors.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.