Mibrain cystic pilocytic astrocytoma
Ali Alkhaibary1, Amani AbuHassan2, Moutasem Azzubi3
1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
Insights
A rare midbrain cystic pilocytic astrocytoma in an 8-year-old girl presented with neurological deficits. Surgical biopsy and aspiration led to immediate improvement, highlighting this rare tumor's presentation and management.
Area of Science:
- Neuro-oncology
- Pediatric Neurosurgery
Background:
- Pilocytic astrocytoma (CNS WHO grade I) commonly affects children, typically arising in the cerebellum or cerebrum.
- Brainstem pilocytic astrocytoma is rare, accounting for only 10% of cases.
- This report details a rare case of a midbrain cystic pilocytic astrocytoma.
Purpose of the Study:
- To describe the clinical and radiological presentation of a rare midbrain cystic pilocytic astrocytoma.
- To highlight the surgical challenges associated with this rare tumor location.
Main Methods:
- Case report of an 8-year-old girl with neurological deficits.
- Brain MRI revealed a cystic lesion with a mural nodule in the midbrain.
- Stereotactic biopsy and aspiration of the cystic component were performed.
Main Results:
- Histopathology confirmed pilocytic astrocytoma (CNS WHO grade 1).
- Post-operative improvement in hemiparesis and facial asymmetry was immediate.
- The patient was initiated on chemotherapy with planned follow-up.
Conclusions:
- Midbrain cystic pilocytic astrocytoma is a rare entity posing surgical challenges.
- This case illustrates the characteristic clinical and radiological features of this rare tumor.
Background:
Pilocytic astrocytoma is a well-circumscribed tumor of the central nervous system (CNS WHO grade I), commonly affecting children. Pilocytic astrocytoma frequently arises from the cerebellum or cerebrum. Pilocytic astrocytoma arising from the brainstem is rare, accounting for 10 % of the cases. We hereby report a patient with midbrain cystic pilocytic astrocytoma.
Case Description:
An 8-year-old girl presented with left-sided upper and lower limbs weakness, facial deviation, and multiple episodes of headache and vomiting for one week. The neurological examination revealed a left-sided hemiparesis (Power: 3/5) and facial weakness (House-Brackman II). Brain MRI showed an expansile cystic lesion with a mural nodule in the right side of the midbrain. The patient underwent stereotactic biopsy of the solid lesion and aspiration of the cystic component. The histopathological sections were compatible with pilocytic astrocytoma; CNS WHO grade 1. Post-operatively, the patient's hemiparesis and facial asymmetry improved immediately. She was commenced on chemotherapy and discharged with periodic clinicoradiological follow-up.
Conclusion:
Midbrain cystic pilocytic astrocytoma is rare and is considered a surgical challenge. The present article describes the clinical and radiological appearance of a patient with midbrain cystic pilocytic astrocytoma.
