Cranial Pilocytic Astrocytoma With Spinal Drop Metastasis in an Adult: Case Report and Literature Review

Munshey, Aasheen; Moore, Justin M.; Maclean, Catriona; Longano, Anthony; Goldschlager, Tony

doi:10.1016/j.wneu.2016.08.013

Cited by 11 publications

(6 citation statements)

References 33 publications

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“…In patient who are detected to have synchronously low-grade glioma with spinal drop metastasis, surgical resection of the intracranial mass and debulking of the spinal lesion may be done. 11 Radiation therapy to all or part of the craniospinal axis or subtotal excision of spinal drops are evaluable option for whom in which disseminated disease was identified after initial diagnosis. 9 In some case series and case report, craniospinal irradiation (CSI) was done for treatment of spinal drop metastasis with good outcome.…”

Section: Discussionmentioning

confidence: 99%

Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Keshri

Sinha²

2022

IJASHNB

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Pilocytic astrocytoma (PA) is a low grade benign tumor, commonly occurs in Cerebellum (42-60%), Optic & hypothalamic region (9-30%), Brain Stem (9%). They rarely spread. It rarely occurs within the ventricle. In this report, we described our experience with cranial pilocytic astrocytoma in a 14-year-old child, who initially treated with near total decompression of tumor. Four and half years later, recurrence of primary tumor with obstructive hydrocephalus occurred for which he underwent ventriculo-peritoneal shunt followed by re-excision. As further treatment was being evaluated for radiotherapy in view of recurrence at the primary site, he got detected to have significant spinal drop metastasis seen on MRI Spine. Finally, he underwent craniospinal irradiation (CSI).

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Section: Discussionmentioning

confidence: 99%

Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Keshri

Sinha²

2022

IJASHNB

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“…These tumors are very closely located to the middle cerebral artery and are surrounded by its branching vessels in a highly eloquent region, which often involves speech, motor, and limbic functions [23]. Approximately 6% of all pLGGs show dissemination either in other parts of the brain or the spine, while in adults dissemination is only observed in high grade gliomas [24,25]. However, the benefit of a whole neuroaxis scan at diagnosis and follow-up is still controversially discussed in pLGG [26].…”

Section: Histology and Anatomical Locationmentioning

confidence: 99%

Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

2021

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Two thirds of pediatric gliomas are classified as low-grade (LGG), while in adults only around 20% of gliomas are low-grade. However, these tumors do not only differ in their incidence but also in their location, behavior and, subsequently, treatment. Pediatric LGG constitute 65% of pilocytic astrocytomas, while in adults the most commonly found histology is diffuse low-grade glioma (WHO II), which mostly occurs in eloquent regions of the brain, while its pediatric counterpart is frequently found in the infratentorial compartment. The different tumor locations require different skillsets from neurosurgeons. In adult LGG, a common practice is awake surgery, which is rarely performed on children. On the other hand, pediatric neurosurgeons are more commonly confronted with infratentorial tumors causing hydrocephalus, which more often require endoscopic or shunt procedures to restore the cerebrospinal fluid flow. In adult and pediatric LGG surgery, gross total excision is the primary treatment strategy. Only tumor recurrences or progression warrant adjuvant therapy with either chemo- or radiotherapy. In pediatric LGG, MEK inhibitors have shown promising initial results in treating recurrent LGG and several ongoing trials are investigating their role and safety. Moreover, predisposition syndromes, such as neurofibromatosis or tuberous sclerosis complex, can increase the risk of developing LGG in children, while in adults, usually no tumor growth in these syndromes is observed. In this review, we discuss and compare the differences between pediatric and adult LGG, emphasizing that pediatric LGG should not be approached and managed in the same way as adult LCG.

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“…It is unclear which route was utilized in our case, but given our patient's known and documented intracranial metastatic lesions, we propose that the lesion was the result of spread from the sub-arachnoid space. In fact, the most commonly advocated mechanism in the literature reviewed was leptomeningeal spread [7,[9][10][11][12][13]. It follows that concurrent intracranial disease is likely to create metastatic disease given the fact that >50% of cases with an intracranial malignancy will demonstrate neoplastic cells in the CSF [9].…”

Section: Mechanism Of Metastasismentioning

confidence: 99%

Intradural extramedullary metastasis: a review of literature and case report

Land

Bowden

Morpeth

et al. 2019

Spinal Cord Ser Cases

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Introduction Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.

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Cranial Pilocytic Astrocytoma With Spinal Drop Metastasis in an Adult: Case Report and Literature Review

Cited by 11 publications

References 33 publications

Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

Intradural extramedullary metastasis: a review of literature and case report

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