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Tumors of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Radiation usually is not indicated for WHO grade I tumors which are best treated with surgical resection. These include: Pilocytic astrocytoma.PXA.DNET.Ganglioglioma.Meningioma: radiation is recommended for WHO grade II meningiomas which are subtotally resected and all WHO grade III meningiomas regardless of degree of resection.
Central Nervous System
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
The treatment of pilocytic astrocytoma is surgical and MSR should be performed. Even if this is incomplete, further tumor progression may not occur. There is no evidence that post-operative radiation improves on surgery alone. If re-growth occurs, the treatment is again surgical. Should the second resection be incomplete, adjuvant radiotherapy can be tried (45–50 Gy), but there is no clear documentation that this is beneficial.
Dysembryoplastic Neuroepithelial Tumor
Published in Dongyou Liu, Tumors and Cancers, 2017
The recommended treatment for DNET is complete surgical resection (e.g., lesionectomy or corticectomy) without adjuvant radiotherapy and chemotherapy, given that radiation therapy is implicated in malignant transformation and that DNET is often resistant to anti-epileptic therapy [8]. Therefore, accurate identification and diagnosis will spare the patients from unnecessary surgery that may lead to potential neurological and cognitive damage. Patients with unresected or incompletely removed DNET or 3 years after complete resection are prone to potential development of pilocytic astrocytoma, recurrence and malignant transformation; long-term follow-up is important [8–10].
Pilocytic astrocytoma with spontaneous malignant transformation with intracranial and skeletal dissemination: case report and review of the literature
Published in British Journal of Neurosurgery, 2022
Subhas K. Konar, B. N. Nandeesh, M. Sandhya, N. Chandana, B. Indira Devi, Dhananjaya I. Bhat
Pilocytic astrocytoma is a benign tumor in comparison to other gliomas with 80% survival rate after 10 years1. Rarely their behavior changes and presents with early recurrence, multicentric disease, leptomeningeal dissemination or very rarely spontaneously malignant transformation with poor prognosis1,2. The risk of malignant transformation is not well ascertained however there may be a history of prior radiotherapy, chemotherapy or atypical histology1. We report an adult patient with a cerebellar pilocytic astrocytoma with multiple early recurrences and spontaneous malignant transformation with cranial and diffuse skeletal dissemination. Both the behaviors in pilocytic astrocytoma are rare and our case is unique as both occurred together.
Audiovestibular findings in a 6 year old child with pilocytic astrocytoma – a case report
Published in International Journal of Audiology, 2020
Aravind Kumar Rajasekaran, A. Arivazhagan, Pradeep Yuvaraj, N. Shivashankar
A 6-year-old child with typically normal development presented with a history of holocranial headache with associated vomiting for 6 months duration. There were no other neurological symptoms such as gait disturbance, dizziness, diplopia, blurred vision, etc. The child did not complain of hearing difficulties nor did the parents suspected. Neurological examination revealed normal findings and there were no cerebellar signs. A Magnetic resonance imaging (MRI) of brain was completed on the child. The MRI (Figure 1) revealed a well-defined irregular lesion sized 3.1 × 4 × 3.2 cc3 (indicated by arrows) involving the left inferior cerebellar peduncle (ICP) and the middle cerebellar peduncle (MCP), extending into the fourth ventricle at the foramen of Luschka and an exophytic component occupying the left cerebellopontine angle (CPA). The child underwent left retromastoid suboccipital craniectomy and decompression of the tumour. During surgery it was noted that the mass was adherent to lower cranial nerves, VII-VIII complex, posterior inferior cerebellar artery (PICA) and the brainstem. It severely compressed the left MCP as well as the ICP and further extended medially into the 4th ventricle through foramen of Lushcka, which had been widened. Histological study revealed pilocytic astrocytoma.
The use of neo adjuvant single-agent vinblastine for tumour shrinkage in a highly vascular paediatric low-grade glioma
Published in British Journal of Neurosurgery, 2020
Vita Stagno, Conor Mallucci, Shivaram Avula, Barry Pizer
She underwent an image-guided craniotomy for cyst marsupialization and tumour biopsy. Histological examination of a small sample showed a LGG, with a favoured diagnosis of Pilocytic Astrocytoma (WHO Grade I) on central review. On microscopy of a small sample, the tumour showed no inherent abnormal vasculature although proliferating blood vessels were seen in a small area of surrounding white matter taken with the tumour. Although not done at diagnosis, subsequent molecular analysis of the tumour showed no BRAF v600 mutation or BRAF fusion genes. Due to the increased risk from surgery with respect to the abnormal tumour vasculature, the neuro-oncology MDT felt that she should be treated with chemotherapy in the first instance. Embolisation was felt to carry a significant risk of complications. First line chemotherapy would generally be a combination of carboplatin and vincristine. However, with respect to the association of carboplatin with myelosuppression, particularly thrombocytopenia, it was decided to treat her with an alternative chemotherapy namely vinblastine.