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Cerebellar astrocytomas: a 24-year experience
J C Viano1, E J Herrera, J C Suárez
1Servicio de Neurocirugia, Hospital Infantil Municipal, Jujuy 3000, CP 5000, Córdoba, Argentina. pediatría@mensajes.com
Insights
Cerebellar astrocytomas, common in children, were surgically treated in 38 pediatric patients. Most tumors were pilocytic astrocytomas, with a high resection rate and an 8.5% mortality.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Central Nervous System (CNS) Tumors
Background:
- Cerebellar astrocytomas represent the most benign central nervous system (CNS) tumors.
- These tumors predominantly affect the pediatric population, accounting for 70-80% of cases.
Purpose of the Study:
- To analyze the treatment and outcomes of cerebellar astrocytomas in children.
- To evaluate the efficacy of surgical management in pediatric patients with posterior fossa astrocytomas.
Main Methods:
- Retrospective analysis of 38 pediatric patients (under 18) with cerebellar astrocytoma treated between 1974 and 1997.
- Inclusion criteria encompassed all histopathological diagnoses of astrocytoma, irrespective of malignancy.
- Diagnostic modalities included pneumoventriculography, X-rays, CT, and MRI, with all patients undergoing surgical intervention.
Main Results:
- Pilocytic astrocytomas constituted the majority (71%), followed by diffuse fibrillary astrocytomas (21%).
- Female patients showed a higher prevalence (66%).
- Total tumor resection was achieved in 83% of cases, with increased ataxia being the most frequent complication and an overall mortality rate of 8.5%.
Conclusions:
- Surgical resection is the primary treatment for pediatric cerebellar astrocytomas.
- Effective management of these tumors can be achieved with a multidisciplinary approach.
- The study highlights the importance of surgical expertise in achieving favorable outcomes and managing complications such as hydrocephalus.
Introduction:
Cerebellar astrocytomas are the most benign tumors of the CNS. Seventy to eighty percent are found in children.
Methods And Results:
We report on 38 children under 18 who had cerebellar astrocytoma in the posterior fossa and were treated by a multidisciplinary team in our Neurosurgical Department from January 1974 to December 1997. We included all patients in whom the histopathological diagnosis was astrocytoma, regardless of malignancy. The diagnostic methods used were pneumoventriculography, cranial X-rays, CT scan, and MRI. All patients were treated surgically. Neither radiotherapy nor chemotherapy was indicated in patients with pilocytic or fibrillary astrocytomas. A greater prevalence was observed in female (25/38; 66%) than in male (13/38; 34%) patients. Histopathological results revealed 27 (71%) pilocytic astrocytomas, 8 (21%) diffuse fibrillary astrocytomas, 1 (2%) anaplastic astrocytoma and 2 (6%) glioblastomas. These tumors were more frequently located in the right cerebellar hemisphere; increased intracranial pressure syndrome was the most frequent form of clinical presentation. Total tumor resection was obtained in 29 (83%) cases and subtotal resection in 9 (17%). In 6 (16%) cases, ventriculoperitoneal shunts were placed to control persistent hydrocephalus after tumor excision.
Conclusion:
The most frequent complication was increased ataxia. The mortality rate was 8.5%.