Long-term outcome after management of pilocytic astrocytoma in the posterior fossa in a pediatric population

Santo, Alejandro N.; Dieckmann, Celina; Rauschenbach, Laurèl; Oppong, Marvin Darkwah; Dinger, Thiemo Florin; Deuschl, Cornelius; Tippelt, Stephan; Fleischhack, Gudrun; Schmidt, Börge; Pierscianek, Daniela; Jabbarli, Ramazan; Wrede, Karsten H.; Müller, Oliver; Sure, Ulrich; Dammann, Philipp

doi:10.1016/j.ibneur.2022.10.001

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…Radical resection is advocated as an essential factor to prevent recurrence; however, an infiltrative lesion with morbid adherence to critical neurovascular structures should be left behind. [ 9 , 19 ] In this index case, the tumor was adherent to the floor of the fourth ventricle, and only subtotal resection was achieved.…”

Section: Discussionmentioning

confidence: 97%

Rare vermian pilocytic astrocytoma with recurrent spontaneous hemorrhage in the elderly: A case report and review of literature

Francis,

Kanaya,

Nagamine

et al. 2024

Surgical Neurology International

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Background: Pilocytic astrocytoma (PA) is a benign glial tumor predominately seen in pediatrics and early adolescence with associated overall good outcomes. Very few cases of elderly PA have been reported in the literature, and they are known to display unique anatomic, histologic, and genetic peculiarities distinct from pediatric disease. We report a rare case of vermian PA in an octogenarian with recurrent spontaneous intratumoral hemorrhage as a presenting symptom. Furthermore, a review of the literature on the peculiarities of PA in the elderly will be discussed. Case Description: An 81-year-old woman presented with features suggestive of repeated posterior fossa hemorrhages characterized by headaches, diplopia, and alteration in sensorium occurring about 5 months apart. Brain neuroimaging showed a cerebellar vermian tumor with features suggestive of repeated intratumoral bleeding. She had an initial ventriculoperitoneal shunting for acute hydrocephalus and subsequently had a suboccipital craniotomy and subtotal tumor excision due to morbid adherence to the brainstem. The histologic diagnosis was PA with Ki-67 <1% and negative for isocitrate dehydrogenase-1. There was a slow but progressive clinical improvement, and she has remained symptom-free for 4 years on follow-up. Conclusion: PA in the elderly is a rare disease with distinct histologic and genetic peculiarities. This case review showed one of the oldest cases of cerebellar vermian PA presenting with recurrent spontaneous intratumoral hemorrhage, an extremely rare occurrence in benign glioma. Although complete surgical excision is recommended, partial resection is advocated for morbidly adherent tumors. Overall prognosis is worse in elderly PA.

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Section: Discussionmentioning

confidence: 97%

Rare vermian pilocytic astrocytoma with recurrent spontaneous hemorrhage in the elderly: A case report and review of literature

Francis,

Kanaya,

Nagamine

et al. 2024

Surgical Neurology International

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“…After second resection, some institutions have provided radiation and/or chemotherapy with a small proportion experiencing progressive disease despite adjuvant therapy [30]. Risks associated with recurrence or tumour progression were extent of resection, invasion as evaluated on T2-weighted MRI scans, predominantly solid lesions, presence of an exophytic component, opticochiasmatic location, and pilomyxoid variant [23,27,38,[38][39][40]. Furthermore, complete removal of the cystic lesions has been controversial though the outcome in cystic tumors is was not signi cantly different between total and subtotal resections [14].…”

Section: Current Standard Of Care For Paediatric Low Grade Gliomasmentioning

confidence: 99%

“…Large case series report repeat surgery in 9-36% [30,41,42] of patients due to progressive tumour recurrence with time to secondary resection ranging between 1 month and 10 years with an even smaller cohort (2-28.5%) undergoing third resection [16,41].Some authors report second look surgery in patients whose initial resection was partial at rates of 40.9% of their STR or 15.8% of their total cohort [40]. In Austin et al's series in 1988, 19/21 recurrences were treated surgically.…”

Section: Re-operation In Posterior Fossa Astrocytomasmentioning

confidence: 99%

“…In the literature there is a trend for higher thresholds for re-resection with increasing understanding of the biological nature of PA. Recurrence after GTR ranged between 5.7%-5.9% [23,40], with a progression-free rate reported between 71.3-75% [23,38]. Furthermore, 10-year progression free survival of cPA is 32% with adjuvant chemotherapy and 65% with adjuvant radiotherapy [26].…”

Section: Re-operation In Posterior Fossa Astrocytomasmentioning

confidence: 99%

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The role of reoperation in paediatric cerebellar pilocytic astrocytoma

Kameda-Smith

Green

Hutton

et al. 2023

Preprint

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Introduction Cerebellar pilocytic astrocytomas (cPAs) in childhood have long been recognized to have a good prognosis after total resection but the final outcome after incomplete surgery remains largely unpredictable with the incidence of symptomatic progressive disease ranging from 18-100%. Traditionally thought that GTR was required for long-term survival, small residuals were classically resected in a subsequent operation. Results Using our Pediatric Low-Grade Glioma (PLGG) database, 283 patients were identified to have a histopathological diagnosis of intracranial pilocytic astrocytoma between 1985-2020 of which 202 were within the cerebellum (68.2%). The majority of patients with cerebellar PA were between 1-10 years of age (n=147, 72.8%) without gender predominance (M:F=101:101), usually presenting with 1 lesion (n=195, 96.5%) and rarely with disseminated disease at diagnosis (N=7, 3.4%). The majority of initial surgeries for cerebellar PA achieved GTR (n=149, 73.8%). In patients with NTR or STR, the mean largest diameter of the post-operative residual was 1.1cm (0.2-3.7cm). Sixty-eight patients experienced relapse of their disease, 4 in which progression was multifocal. In 31 patients the neuro-oncology MDT recommended a second surgical resection at a mean time interval of 22.9 months (0.13-81.6 months) from the initial surgery. The children in the multiple operation cohort experienced more complications of therapy including ongoing endocrinopathy, treatment-associated hearing deficit, and neurocognitive deficiencies. Conclusion Residual disease in cPA should be maintained under clinocoradiological surveillance post-operatively with a more conservative approach when residual disease is not significantly changing over time.

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Reply to letter that comments on “Trigeminal nerve chronic motor denervation caused by cerebellar peduncle pilocytic astrocytoma”

Papangelopoulou,

Ansari,

Bartoli

et al. 2024

Childs Nerv Syst

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Long-term outcome after management of pilocytic astrocytoma in the posterior fossa in a pediatric population

Cited by 7 publications

References 25 publications

Rare vermian pilocytic astrocytoma with recurrent spontaneous hemorrhage in the elderly: A case report and review of literature

Rare vermian pilocytic astrocytoma with recurrent spontaneous hemorrhage in the elderly: A case report and review of literature

The role of reoperation in paediatric cerebellar pilocytic astrocytoma

Reply to letter that comments on “Trigeminal nerve chronic motor denervation caused by cerebellar peduncle pilocytic astrocytoma”

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