[Clinical investigation of cerebellar astrocytomas in childhood]

Between 1970 and 1985, 58 children with pathologically proven cerebellar astrocytoma were treated at the Children's Memorial Hospital in Chicago. Histological distribution indicated 54 were Grade 1-2 and the remaining 4 patients had Grade 3 astrocytoma. Thirty-eight were evaluated by CT scans and classified into 3 groups, (1) cyst with mural nodule, (2) cyst within tumor and (3) solid type. All patients underwent a posterior fossa craniotomy and 2 cases (3.4%) died shortly after the operation. Forty-two patients underwent visible total resection and 16 subtotal or less resection. The recurrence rate in subtotal resection group (53.3%) is much higher than in total resection group (9.8%) (p less than 0.01) and the highest in solid type. Seven out of 8 cases who developed recurrence after subtotal removal were in the midline location, and 6 out of 7 cases who did not show any recurrence were cystic in nature. About two-thirds of patients had good outcome, 32% had fair and 4% had poor outcome. The hemispheric tumors led the patient to a better outcome but the midline solid tumors caused poor outcome. Fifty patients were diagnosed to have hydrocephalus preoperatively. Postoperative permanent hydrocephalus developed in at least 30% of the patients, and was more common in the midline solid type tumor. We stress that an attempt of total resection should be done at initial craniotomy. Residual or recurrent tumor are to be resected if they show increasing size on serial CT scans or cause symptoms. Radiotherapy does not afford any additional effects to benign cerebellar astrocytomas.