Cerebellar pilocytic astrocytomas in children: results, remnants, and recurrences. A series of 72 cases

Background and purpose: Cerebellar pilocytic astrocytoma (CPA) bears a well -deserved reputation of benignity. However, these tumors infiltrate the bra instem in a number of cases, and total removal may cause morbidity, whereas subtotal removal can lead to recurrence. Material and methods: To define guidelines for tumor removal, management of tumor remnants and recurrence, we reviewed 72 cases of CPA of childhood op erated on in our department since the introduction of CT. Results: Surgical removal was total in 57 cases, had to be withheld because of brainstem infiltration in nine cases, and was revealed subtotal by post operative imaging in six cases. Two of tile latter were reoperated on; six had only radiological controls and did not progress. Early in the series, e ight children had external irradiation because of subtotal removal or recur rence. Three children were reoperated on for tumor recurrence, between sis and eight years after complete removal. We had no tumor-related mortality; long-term disability could be related to previous mental retardation, the s everity of clinical state at presentation, and complications of surgery and irradiation. Conclusion : The goal of surgery is to cure the patient with minimal morbid ity, however; total removal is not always possible. In our experience : i) tumor remnants can be surveyed radiologically, and reoperated only in case of progression; ii) the indications for radiotherapy should be the exceptio n; iii) clinical and radiological follow-rip should be protected beyond ent ry into adulthood.