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CEREBELLAR ASTROCYTOMAS

Cerebellar Astrocytomas are one of the more common pediatric Brain tumors (10%), comprising 27% of pediatric Posterior Cranial Fossa tumors. They are much less common in adults. The post-operative survival is longer than other types of Astrocytomas.

SYMPTOMS

The most frequent and almost universal symptom is Headache with or without Nausea and Vomiting (these latter symptoms usually occur later in the course of the disease when the intracranial pressure is abnormally increased.) In additional to all of the symptoms present in patients with increased intracranial pressure, tumors in the Posterior Cranial Fossa can cause Gait Disturbance, increased Clumsiness as well as Double Vision (Diplopia.)

DIAGNOSIS

MRI Scan is the most reliable and accurate neuroimaging procedure.


TREATMENT

Surgery

Surgical excision of the maximal amount of the tumor that can be removed, without producing neurological deficits, is the appropriate treatment. In tumors composed of a nodule and a cyst, excision of the nodule is usually definitive therapy. These patients generally have a high rate of long term (5 to 10 or more year) survival.

Figure 4: Operative Photo (Same Patient)

Opening of the Left Cerebellar Hemisphere to reveal the "Mural Nodule" (Curved Arrow)
Part of the Cyst wall can be seen just below the "Nodule" (Horizontal Arrow.)

Figure 5: Operative Photo same patient)

There is a large residual "Cystic Cavity" (Arrows) AFTER the "Mural Nodule" has been widely excised.

The Cyst "Wall" is made of "compressed normal" tissue.

There is no reason to remove any further tissue.

See Follow-up MRI Scans below.

Radiation Therapy

Radiation therapy is not recommended in these cases, since the complication rates of Radiation Therapy in patients whose expected survival for 5 or more years, is quite high.

Follow-up Required

Careful attention to follow up is required using repeat MRI scans. Repeat operation is appropriate, if there is a recurrence of the tumor.

Figure 8: MRI Scan (Sagittal View-Post-Gadolinium)

Compare this to the Pre-operative MRI in Figure 3.

The patient made a rapid post-operative recovery and remains without symptoms.

Note the tiny remnant of "scarred" Cyst wall (Arrow). THIS MUST BE FOLLOWED with MRI Scans.

Chemotherapy

Chemotherapy is not appropriate for these tumors since the lesions are not aggressive and are usually definitively managed by direct surgical resection.



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This page last edited on 2/19
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Author, Martin L. Lazar, MD, FACS
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