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[A case of infantile anaplastic astrocytoma treated with surgery and chemotherapy]
M Saino1, T Kayama, K Sakurada
1Department of Neurosurgery, Yamagata University School of Medicine.
Insights
A pediatric anaplastic astrocytoma was successfully removed, followed by chemotherapy. This approach ensured satisfactory growth and development in the infant, avoiding radiation side effects.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Neuro-oncology
Background:
- Anaplastic astrocytoma is a rare and aggressive brain tumor in infants.
- Early diagnosis and effective treatment are crucial for favorable outcomes.
Observation:
- A 5-month-old infant presented with macrocephaly, right hemiparesis, and a bulging anterior fontanel.
- MRI revealed a large, enhancing tumor in the left frontal and parietal lobes.
- Cerebral angiography identified the central sulcus artery and posterior parietal artery as the main feeding vessels.
Findings:
- The tumor was completely resected via sulcotomy with temporary arterial clipping.
- Histological diagnosis confirmed anaplastic astrocytoma.
- Postoperative chemotherapy with VP-16 and CDDP was administered, avoiding radiation therapy.
- Tumor recurrence has not been observed in over 2.5 years, with satisfactory neurodevelopmental outcomes.
Implications:
- Complete surgical resection combined with adjuvant chemotherapy offers a promising treatment strategy for infant anaplastic astrocytoma.
- This approach minimizes the risk of long-term neurodevelopmental deficits associated with radiation therapy.
- Preserving neurological function during surgery is paramount for optimizing the quality of survival.
Abstract:
A 5-month-old girl presented with enlargement of the head circumference. Neurological examination revealed right hemiparesis and bulging of the anterior fontanel. T1-weighted magnetic resonance imaging with gadolinium DTPA showed a well-enhanced, huge tumor extending from the left frontal lobe to the parietal lobe. Cerebral angiography showed the main feeding arteries were the central sulcus artery and the posterior parietal artery. The tumor was totally removed using a sulcotomy and temporary clipping of these feeding arteries to control bleeding. The histological diagnosis was anaplastic astrocytoma. Postoperative radiation therapy was avoided so as to prevent the side effect of radiation therapy such as mental retardation and growth impairment. Chemotherapy using VP-16 and CDDP was given every six months as adjunct therapy. No tumor recurrence has been recognized for over a period of 2 years and 5 months after surgery and growth and mental development have been satisfactory. Total removal using great care not to damage neurological function followed by postoperative chemotherapy is the treatment of preference to obtain good prognosis and quality of survival in infant with such tumors.