Acta Neurochirurgica

, Volume 155, Issue 8, pp 1431–1435 | Cite as

Cerebellar pilocytic astrocytoma in adults: a management paradigm for a rare tumour

  • Antonia Wade
  • Caroline Hayhurst
  • Anthony Amato-Watkins
  • Alistair Lammie
  • Paul Leach
Clinical Article - Brain Tumors



Pilocytic astrocytoma is one of the commonest subtypes of glioma to affect children. However, they are rarely diagnosed in patients over the age of 18 years. In adults, these tumours appear more frequently supra-tentorially than in the cerebellum and some reports suggest a different clinical course in adults. We reviewed ten patients aged 18 or over who had been operated on for cerebellar pilocytic astrocytoma to assess the impact of tumour biology and extent of resection on outcome in adults.


Patients were identified from a neuropathology database and a retrospective chart review of ten patients was performed. Recorded data included patient demographics, tumour location, presenting features, radiological appearance, extent of surgical resection, tumour recurrence and Ki-67 proliferation index.


Nine patients were men and one patient was a woman. Median follow up is 41.5 months (range 15–334 months). Complete surgical resection was achieved in nine of the patients operated in our institution. One patient had prior subtotal resection elsewhere. Tumour recurrence was seen only in the two patients with subtotal resection, at 7 and 25 years. Ki-67 ranged from <1 to 10 % and appears to have no correlation to recurrence. No patients in this series had adjuvant treatment.


Cerebellar pilocytic astrocytomas in adults should be treated with macroscopic complete surgical resection whenever possible. If this is achieved, long-term survival rates are excellent, whereas subtotal resection carries a high risk of tumour recurrence. Ki-67 is less important prognostically than the extent of initial resection.


Pilocytic astrocytoma Posterior fossa Cerebellum Adult tumour 


Conflicts of interest



  1. 1.
    Bar EE, Lin A, Tihan T, Burger PC, Eberhart CG (2008) Frequent gains at chromosome 7q34 involving BRAF in pilocytic astrocytoma. J Neuropathol Exp Neurol 67:878–887PubMedCrossRefGoogle Scholar
  2. 2.
    Bell D, Chitnavis BP, Al-Sarraj S, Connor S, Sharr MM, Gullan RW (2004) Pilocytic astrocytoma of the adult—clinical features, radiological features and management. Br J Neurosurg 18:613–616PubMedCrossRefGoogle Scholar
  3. 3.
    Brown PD, Buckner JC, O’Fallon JR, Iturria NL, Brown CA, O’Neill BP, Scheithauer BW, Dinapoli RP, Arusell RM, Abrams RA, Curran WJ, Shaw EG (2004) Adult patients with supratentorial pilocytic astrocytomas: a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys 58:1153–1160PubMedCrossRefGoogle Scholar
  4. 4.
    Burkhard C, Di Patre PL, Schuler D, Schuler G, Yasargil MG, Yonekawa Y, Lutolf UM, Kleihues P, Ohquki H (2003) A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 98:1170–1174PubMedCrossRefGoogle Scholar
  5. 5.
    Daumas-Duport C, Scheithauer B, O’Fallon J, Kelly P (1988) Grading of astrocytomas. A simple and reproducible method. Cancer 62:2152–2165PubMedCrossRefGoogle Scholar
  6. 6.
    Ellis JA, Waziri A, Balmaceda C, Canoll P, Bruce JN, Sisti MB (2009) Rapid recurrence and malignant transformation of pilocytic astrocytoma in adult patients. J Neurooncol 95:377–382PubMedCrossRefGoogle Scholar
  7. 7.
    Forsyth PA, Shaw EG, Scheithauer BW, O’Fallon JR, Layton DD Jr, Katzmann JA (1993) Supratentorial pilocytic astrocytomas. A clinicopathologic, prognostic, and flow cytometric study of 51 patients. Cancer 72:1335–1342PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia DM, Fulling KH (1985) Juvenile pilocytic astrocytoma of the cerebrum in adults. A distinctive neoplasm with favorable prognosis. J Neurosurg 63:382–386PubMedCrossRefGoogle Scholar
  9. 9.
    Haapasalo H, Sallinen S, Sallinen P, Helen P, Jaaskelainen J, Salmi TT, Paetau A, Paljarvi L, Visakorpi T, Kalimo H (1999) Clinicopathological correlation of cell proliferation, apoptosis and p53 in cerebellar pilocytic astrocytomas. Neuropathol Appl Neurobiol 25:134–142PubMedCrossRefGoogle Scholar
  10. 10.
    Hallemeier CL, Pollock BE, Schomberg PJ, Link MJ, Brown PD, Stafford SL (2012) Stereotactic radiosurgery for recurrent or unresectable pilocytic astrocytoma. Int J Radiat Oncol Biol Phys 83:107–112PubMedCrossRefGoogle Scholar
  11. 11.
    Hasselblatt M, Riesmeier B, Lechtape B, Brentrup A, Stummer W, Albert FK, Sepehrnia A, Ebel H, Gerss J, Paulus W (2011) BRAF-KIAA1549 fusion transcripts are less frequent in pilocytic astrocytomas diagnosed in adults. Neuropathol Appl Neurobiol 37:803–806PubMedCrossRefGoogle Scholar
  12. 12.
    Ishkanian A, Laperriere NJ, Xu W, Millar BA, Payne D, Mason W, Sahgal A (2011) Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer 117:4070–4079PubMedCrossRefGoogle Scholar
  13. 13.
    Johnson DR, Brown PD, Galanis E, Hammack JE (2012) Pilocytic astrocytoma survival in adults: analysis of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. J Neurooncol 108:187–193PubMedCrossRefGoogle Scholar
  14. 14.
    Kano H, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2009) Stereotactic radiosurgery for pilocytic astrocytomas part 1: outcomes in adult patients. J Neurooncol 95:211–218PubMedCrossRefGoogle Scholar
  15. 15.
    Laws ER Jr, Taylor WF, Clifton MB, Okazaki H (1984) Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61:665–673PubMedCrossRefGoogle Scholar
  16. 16.
    Sallinen PK, Haapasalo HK, Visakorpi T, Helen PT, Rantala IS, Isola JJ, Helin HJ (1994) Prognostication of astrocytoma patient survival by Ki-67 (MIB-1), PCNA, and S-phase fraction using archival paraffin-embedded samples. J Pathol 174:275–282PubMedCrossRefGoogle Scholar
  17. 17.
    Schneider JH Jr, Raffel C, McComb JG (1992) Benign cerebellar astrocytomas of childhood. Neurosurgery 30:58–62, discussion 62–3PubMedCrossRefGoogle Scholar
  18. 18.
    Stuer C, Vilz B, Majores M, Becker A, Schramm J, Simon M (2007) Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer 110:2799–2808PubMedCrossRefGoogle Scholar
  19. 19.
    Tomlinson FH, Scheithauer BW, Hayostek CJ, Parisi JE, Meyer FB, Shaw EG, Weiland TL, Katzmann JA, Jack CR Jr (1994) The significance of atypia and histologic malignancy in pilocytic astrocytoma of the cerebellum: a clinicopathologic and flow cytometric study. J Child Neurol 9:301–310PubMedCrossRefGoogle Scholar
  20. 20.
    Tonn JC, Westphal M, Rutka JT, Grossman SA (2006) Neuro-oncology of CNS tumors. Springer, New YorkCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Antonia Wade
    • 1
  • Caroline Hayhurst
    • 1
  • Anthony Amato-Watkins
    • 1
  • Alistair Lammie
    • 2
  • Paul Leach
    • 1
  1. 1.Department of NeurosurgeryUniversity Hospital of WalesCardiffUK
  2. 2.Department of NeuropathologyUniversity Hospital of WalesCardiffUK

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