Wjr. Van Ouwerkerk et Cmf. Dirven, Hematoma in a low grade medullary astrocytoma: report of an unusual case and literature review, CHILD NERV, 14(12), 1998, pp. 742-746
We describe the case to our knowledge unique - of an 8-year-old boy who pre
sented with acute onset of lower cranial nerve palsy and tetraparesis cause
d by a hematoma in a dorsal exophytic pilocytic astrocytoma of the medulla
oblongata. The boy showed near-complete recovery after neurosurgical manage
ment in two stages: first, emergency evacuation of the hematoma with tumor
biopsy, and second, complete tumor removal 5 months after the initial event
. Intraoperative electrophysiological monitoring techniques for the lower c
ranial nerves are of value in preserving their functional integrity. Ultras
onography is helpful in assessing the extent of tumor removal. Although the
pathological diagnosis of a pilocytic astrocytoma would not justify radiot
herapy, local field radiotherapy was added mainly because of the unexpected
ly rapid tumor progression during the interval between the two surgical pro
cedures. The literature on brainstem and tumor hematoma in children is revi
ewed.