CASE REPORTS   

Journal of Neurosurgical Sciences 1999 December;43(4):299-304

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English

Dorsally exophytic brain stem tumors: total removal of a medullary pilocytic astrocytoma in child. Clinicopathological considerations and case report

Amato V. G. ¹, Arienta C. ¹, Sparacio F. ²

¹ Neurosurgical Division of Ospedale Fatebenefratelli, Milan, Italy; ² Pathology Service of Ospedale Fatebenefratelli, Milan, Italy

­The ­authors ­describe ­the ­case of 4-­year-­old ­girl ­who ­was oper­at­ed on ­for a pil­o­cyt­ic astro­cy­to­ma of ­the ­brain ­stem, exo­phyt­ic ­and pro­trud­ed back­ward ­into ­the ­fourth ven­tri­cle. ­The remov­al ­through a sub­oc­cip­i­tal mid­line ­approach ­was per­formed ­and mac­ro­scop­i­cal­ly com­plete. Post­op­er­a­tive com­pli­ca­tions com­pelled a ­heavy rean­i­ma­tion ­with a pro­longed fol­low-up ther­a­py. ­The neu­ro­log­i­cal recov­ery ­was favor­able. ­Three ­years lat­er, ­this lit­tle ­girl is ­almost auton­o­mous in ­all dai­ly activ­ities. Post­op­er­a­tive ­scans ­showed ­total ­tumor resec­tion. ­The ­patient ­received no com­ple­men­tary treat­ment ­such as radio­ther­a­py, chem­o­ther­a­py or cor­ti­co­ther­a­py. ­The ­long-­term sur­vi­val, with­out ­the ­need ­for adjunc­tive ther­a­py, con­firms ­the ­good prog­no­sis ­for ­this unusu­al ­group of brain stem ­tumors. ­The cli­nic­o­path­o­log­i­cal­ ­and radio­log­i­cal­ fea­tures ­are ­described ­and sur­gi­cal ques­tions ­are dis­cussed expe­cial­ly regard­ing com­plete or sub­to­tal remov­al of brain­ stem ­tumors in demar­cat­ed-­benign astro­cy­to­mas.