Ten years observation and treatment of multifocal pilocytic astrocytoma

Pilocytic astrocytoma (PA) usually occurs in younger patients. It is a benign, generally well-delineated, WHO grade I tumour with favorable prognosis, which makes it different from diffuse astrocytomas, classified as higher grades of malignancy. A case study of PA was presented in a young female patient, observed and treated at the Neurosurgical Department for the period of 10 years, during which time she had frequent surgical procedures due to recurrence and dissemination of the tumour. The initial symptom of the disease was epileptic seizure at the age of 16. Neuroradiological study revealed cerebral tumour in the right temporal lobe, then the first temporal lobe surgery followed by re-operation and radiotherapy was performed. The patient developed hydrocephalus, treated with the ventriculo-peritoneal shunt. After 5 years local recurrence of the tumour appeared in the right temporal region. The patient was operated and the tumour was totally removed. Initially, the histopathological diagnosis of ganglioglioma was suggested for primary tumour, finally the diagnosis of pilocytic astrocytoma for both recurrent and primary tumour was established. During the next years of observation increasing neurological symptoms in lower limbs developed. Subsequently, the patient reported pain syndrome in lumbosacral and perineal area. Consecutive MRI studies revealed a spinal canal tumours localized at the thoracic level and next at sacral level. The spinal tumour was surgically treated in both locations; the last operation was done 10 years after surgery of the primary temporal lobe tumour. Histopathological examinations of the excised foci from spinal canal revealed neoplasm consistent with WHO grade I pilocytic astrocytoma. The presented case indicates that despite the spread of the neoplastic process, a histopathologically benign tumour (WHO I grade) allows for long-term survival and observation period. Unfortunately, multifocal tumour involving midline structures causes major neurological symptoms and deficits. In the presented case we dealt now with the ascending spread process and the occurrence of the new foci in both subtentorial and parameningeal spaces inside the cranial cavity. It is a rare clinical manifestation of a disease ever described in the literature.