Cerebellar astrocytomas: a 24-year experience

Introduction: Cerebellar astrocytomas are the most benign tumors of the CNS . Seventy to eighty percent are found in children. Methods and results: We report on 38 children under 18 who had cerebellar astrocytoma in the poster ior fossa and were treated by a multidisciplinary team in our Neurosurgical Department from January 1974 to December 1997. We included all patients in whom the histopathological diagnosis was astrocytoma, regardless of malign ancy. The diagnostic methods used were pneumoventriculography, cranial X-ra ys, CT scan, and MRI. All patients were treated surgically. Neither radioth erapy nor chemotherapy was indicated in patients with pilocytic or fibrilla ry astrocytomas. A greater prevalence was observed in female (25/38; 66%) t han in male (13/38; 34%) patients. Histopathological results revealed 27 (7 1%) pilocytic astrocytomas, 8 (21%) diffuse fibrillary astrocytomas, 1 (2%) anaplastic astrocytoma and 2 (6%) glioblastomas. These tumors were more fr equently located in the right cerebellar hemisphere; increased intracranial pressure syndrome was the most frequent form of clinical presentation. Tot al tumor resection was obtained in 29 (83%) cases and subtotal resection in 9 (17%). In 6 (16%) cases, ventriculoperitoneal shunts were placed to cont rol persistent hydrocephalus after tumor excision. Conclusion: The most fre quent complication was increased ataxia. The mortality rate was 8.5%.