Hematoma in a low grade medullary astrocytoma: report of an unusual case and literature review

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.