Radical Resection of Cerebellar Juvenile Pilocytic Astrocytoma - A 22-Year Survival: A Case Report

Abstract

Summary Juvenile pilocytic astrocytoma (JPA) is a low-grade glioma, a most common astrocytoma in young patients. It is a tumor with relatively well-defined margins. Pilocytic astrocytomas (PA) comprise approximately 5-6% of all gliomas. Gross total resection ensures a radical cure of patients and long-time survival. In the literature, the data on the survival rate of more than 20 years is scarce. A 5.5-year old boy with a history of 3-month complaints of headache, dizziness, and vomiting was diagnosed after CT to harbour a hypodense cerebellar tumor mass, situated in the midline-right hemisphere. The compression of the fourth ventricle resulted in rostral hydrocephalus with transependymal resorption. Within a week, a VP shunt was applied, followed by a radical Nafziger-Town operation. Gross total resection of the tumor was achieved. Profound clinical improvement was observed immediately after the operation. Postoperative CT scans, including the ones 22 years after the operation, remained practically normal. The patient is now 28-year old and is a perspective economist now. He leads a healthy working life. In general, the prognosis is excellent. If the tumor is completely removed by surgery, the chances of being “cured” are very high. Pilocytic astrocytoma has a five-year survival rate in over 96 percent in children and young adults, which is one of the highest survival rates of any brain tumor. However, there is even a small percent possibility for malignant transformation (1-4%).