Skip to main content

Advertisement

SpringerLink
Log in

Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

In a retrospective study of 73 patients operated on for cere-bellar pilocytic astrocytomas, results of treatment, outcome and biological behaviour of residual tumour were analysed. Complete tumour resection proven by CT or MRI scans within 1 year after surgery was achieved only in 69% of cases. In 31% of cases the surgeon’s opinion on the extent of surgical resection was not borne out by the result of postoperative neuroimaging. Progression of residual tumour or tumour recurrence appeared in 19% of patients, 1 patient showed metastatic spread along the craniospinal axis, and in 1 patient malignant degeneration appeared during follow-up. Stable residual tumour or regression of residual tumour was seen in 14% of patients. Outcome after surgical treatment, which was combined with irradiation in 10 patients (14%), was favourable in 80% and unfavourable in 20% of patients. This outcome of treatment was not influenced by a second operation for progression of residual tumour or recurrent tumour. Characteristics of patients with tumour progression after the first operation did not differ from those of the whole group. There were 17 reoperations for residual or recurrent tumour, 10 of which took place within 4 years after the initial surgical treatment. Surgery-related morbidity was 15% and mortality 4%. Irradiation to residual tumour in 8 patients was followed by complete regression in 1 patient, progression in 4 patients and no changes in 1 patient. For the remaining 2 patients the effect of irradiation on the residual tumour is unknown. Factors that determine the prognosis are discussed on the basis of this retrospective analysis and the data from the literature. It is concluded that optimal treatment for a cerebellar pilocytic astrocytoma does not consist solely in surgery with the aim of total tumour removal and careful tumour handling in order to avoid spread of tumour cells and subsequent metastases and additional radiation therapy in strictly selected cases, but also in posttreatment follow-up based on direct postoperative neuroimaging, preferably by MRI. An algorithm for postoperative follow-up management is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alpers CE, Davis RL, Wilson CB (1982) Persistence and late malignant transformation of childhood cerebellar astrocytoma. J Neurosurg 57: 548–551

    PubMed  CAS  Google Scholar 

  2. Auer RN, Rice GPA, Hinton GG, Amacher AL, Gilbert JJ (1981) Cerebellar astrocytoma with benign histology and malignant clinical course. J Neurosurg 54: 128–132

    PubMed  CAS  Google Scholar 

  3. Austin EJ, Alvord EC (1988) Recurrences of cerebellar astrocytomas. A violation of Collin’s law. J Neurosurg 68: 41

    PubMed  CAS  Google Scholar 

  4. Bernell WR, Kepes JJ, Seitz EP (1972) Late malignant recurrence of childhood cerebellar astrocytoma. J Neurosurg 37: 470–474

    PubMed  CAS  Google Scholar 

  5. Bodian M, Lawson D (1953) The intracranial neoplastic diseases of childhood. Br J Surg 40: 368–392

    Article  PubMed  CAS  Google Scholar 

  6. Bucy PC, Thieman PW (1968) Astrocytomas of the cerebellum. Arch Neurol 18: 14–19

    PubMed  CAS  Google Scholar 

  7. Budka M (1975) Partially resected and irradiated cerebellar astrocytoma of childhood. Acta Neurochir 32: 139–146

    Article  CAS  Google Scholar 

  8. Cushing H (1931) Experiençes with the cerebellar astrocytomas, a critical review of seventy-six cases. Surg Gynecol Obstet 52: 129–204

    Google Scholar 

  9. Davis CH, Joglekar VM (1981) Cere-bellar astrocytomas in children and young adults. J Neurol Neurosurg Psychiatry 44: 820–828

    Article  PubMed  CAS  Google Scholar 

  10. Eade OE, Urich A (1971) Metastasising gliomas in young subjects. J Pathol (Lond) 103: 245–256

    CAS  Google Scholar 

  11. Ferbert A, Gullotta F (1985) Remarks on the follow-up of cerebellar astrocytomas. J Neurol 232: 134–136

    Article  PubMed  CAS  Google Scholar 

  12. Garcia DM, Latifi HR, Simpson JR, Picker S (1989) Astrocytomas of the cerebellum in children. J Neurosurg 71: 661–664

    PubMed  CAS  Google Scholar 

  13. Geissinger JD, Bucy PC (1971) Astrocytomas of the cerebellum in children. Long-term study. Arch Neurol 24: 125

    PubMed  CAS  Google Scholar 

  14. Gjerris F, Klinken L (1978) Long-term prognosis in children with benign cerebellar astrocytoma. J Neurosurg 49: 179–184

    PubMed  CAS  Google Scholar 

  15. Griffin TW, Beaufait D, Blasko JC (1979) Cystic cerebellar astrocytomas in childhood. Cancer 44: 276–280

    Article  PubMed  CAS  Google Scholar 

  16. Hojer C, Hildebrandt G, Lanfermann H, Schroder R, Haupt WF (1994) Pilocytic astrocytomas of the posterior fossa: a follow-up study in 33 patients. Acta Neurochir 129: 131–139

    Article  CAS  Google Scholar 

  17. Ilgren EB, Stiller CA (1986) Cerebellar astrocytomas: therapeutic managment. Acta Neurochir 81: 11–26

    Article  CAS  Google Scholar 

  18. Kehler U, Arnold H, Muller H (1990) Long-term follow-up of infratentorial pilocytic astrocytomas. Neurosurg Rev 13: 315–320

    Article  PubMed  CAS  Google Scholar 

  19. Kepes JJ, Lewis RC, Vergara GG (1980) Cerebellar astrocytoma invading the musculature and the soft tissues of the neck. Case report. J Neurosurg 52: 414–418

    PubMed  CAS  Google Scholar 

  20. Kepes JJ, Whittaker CK, Watson K, Morantz RA, Millett R, Clough CA, Oxley DK (1989) Cerebellar astrocytomas in elderly patients with very long preoperative histories: report of three cases. Neurosurgery 25: 258–264

    Article  PubMed  CAS  Google Scholar 

  21. Kleinman GM, Schoene WC, Walshe TM, Richardson EP (1978) Malignant transformation in benign cerebelllar astrocytoma. J Neurosurg 49: 111–118

    PubMed  CAS  Google Scholar 

  22. Lapras C, Patet JD, Lapras C Jr, Mottolese C (1986) Cerebellar astrocytomas in childhood. Child’s Nerv Syst 2: 55–59

    Article  CAS  Google Scholar 

  23. Lapras C, Patet JD, Mottolese C, Vitale G (1987) Cerebellar astrocytomas in children. Prog Exp Tumor Res 30: 128–134

    PubMed  CAS  Google Scholar 

  24. Laws ER, Bergstralh EJ, Taylor WF (1987) Cerebellar astrocytoma in children. Prog Exp Tumor Res 30: 122–127

    PubMed  Google Scholar 

  25. Mamelak AN, Prados MD, Obana WG, Cogen PH, Edwards MSB (1994) Treatment options and prognosis for multicentric juvenile pilocytic astrocytoma. J Neurosurg 81: 24–30

    PubMed  CAS  Google Scholar 

  26. McLaughlin JE (1976) Juvenile astrocytomas with subarachnoid spread. J Pathol (Lond) 118: 101–107

    CAS  Google Scholar 

  27. Mishima K, Nakamura M, Nakamura H, Nakamura O, Funata M, Shitara M (1992) Leptomeningeal dissemination of cerebellar pilocytic astrocytoma. J Neurosurg 77: 788–791

    Article  PubMed  CAS  Google Scholar 

  28. Palma L, Russo A, Celli P (1984) Prognosis of the so-called “diffuse” cerebellar astrocytoma. Neurosurgery 15: 315–317

    Article  PubMed  CAS  Google Scholar 

  29. Russell DS, Rubinstein LJ (1971) Pathology of tumors of the nervous system, 3rd edn. Arnold, London, pp 136–142

    Google Scholar 

  30. Shapiro K, Katz M (1983) The recurrent cerebellar astrocytoma. Child’s Brain 10: 168

    PubMed  CAS  Google Scholar 

  31. Shapiro K, Shulman K (1976) Spinal cord seeding from cerebellar astrocytomas. Child’s Brain 2: 177–186

    PubMed  CAS  Google Scholar 

  32. Szenasy J, Slowik F (1983) Prognosis of benign cerebellar astrocytomas in children. Child’s Brain 10: 39–47

    PubMed  CAS  Google Scholar 

  33. Tomlinson FH, Scheithauer BW, Hayostek CJ, Patisi JE, Meyer FB, Shaw EG, Weiland TL, Katzmann JA, Jack CR (1994) The significance of atypia and histologic malignancy in pilocytic astrocytoma of the cerebellum: a clinicopathologic study and flow cytometric study. J Child Neurol 9: 301–310

    Article  PubMed  CAS  Google Scholar 

  34. Undjian S, Marinov M, Georgiev K (1989) Long-term follow-up after surgical treatment of cerebellar astrocytomas in 100 children. Child’s Nerv Syst 5: 99–101

    Article  CAS  Google Scholar 

  35. Ushio Y, Arita N, Yoshimine T, Ikeda T, Mogami H (1987) Malignant recurrence of childhood cerebellar astrocytoma: case report. Neurosurgery 21: 251–255

    Article  PubMed  CAS  Google Scholar 

  36. Wallner KE, Gonzales MF, Edwards MSB, Wara WM, Sheline GE (1988) Treatment results of juvenile pilocytic astrocytoma. J Neurosurg 69: 171–176

    PubMed  CAS  Google Scholar 

  37. Winston K, Gilles FH, Leviton A, Fulchiero A (1977) Cerebellar gliomas in children. J Natl Cancer Inst 58: 833–838

    PubMed  CAS  Google Scholar 

  38. Wisoff HS, Llena JF (1989) Glioblastoma multiforme of the cerebellum five decades after irradiation of a cerebellar tumor. J Neurooncol 7: 339–344

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Free University Hospital, De Boelelaan 1117, NL-1081, HV Amsterdam, The Netherlands

    C. M. F. Dirven

  2. Department of Neurosurgery, University Hospital Groningen, P.O. Box 30.001, NL-9700, RB Groningen, The Netherlands

    J. J. A. Mooij

  3. Department of Pathology, University Hospital Groningen, P.O. Box 30.001, NL-9700, RB Groningen, The Netherlands

    W. M. Molenaar

Authors
  1. C. M. F. Dirven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. J. A. Mooij
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. M. Molenaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dirven, C.M.F., Mooij, J.J.A. & Molenaar, W.M. Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Child’s Nerv Syst 13, 17–23 (1997). https://doi.org/10.1007/s003810050033

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s003810050033

Key words

Search

Navigation