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Overall Management
> Astrocytic
Tumors
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Journal of Neurosurgery: Pediatrics,
December 2006 Volume 105 Number 6
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Abstract |
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Spinal cord pilocytic
astrocytoma with leptomeningeal dissemination to the brain. Case
report and review of the literature
Taylor J. Abel,
Abhineet Chowdhary, Mahesh Thapa, Joe C. Rutledge, J. Russell Geyer,
Jeffrey Ojemann and Anthony M. Avellino
Departments of Neurological Surgery,
Radiology, and Laboratory Medicine, Division of Hematology/Oncology,
Children’s Hospital and Regional Medical Center, University of
Washington School of Medicine, Seattle, Washington
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Leptomeningeal dissemination of low-grade
spinal cord gliomas is an uncommon event.
The authors report a unique case of
leptomeningeal dissemination of a spinal cord pilocytic astrocytoma (PCA)
to the intracranial cerebral subarachnoid spaces in a child.
A 2-year-old boy presented with a loss of
balance and the inability to walk or stand.
An intradural intramedullary spinal cord
tumor was identified, and the lesion was subtotally resected and
diagnosed by the pathology department to be a PCA.
Subsequently, the patient had recurrences
of the intradural intramedullary tumor at 6 months and 2 years after
his original presentation.
He underwent a repeated resection of the
recurrent tumor and fenestration of an associated syrinx on both
occasions.
The pathological characteristics of the
reresected tumor remained consistent with those of a PCA.
Postoperative imaging after his last
surgery revealed diffuse intracranial leptomeningeal dissemination
into the cisternal space surrounding the midbrain, the suprasellar
region, and the internal auditory canal, as well as nodular
subarachnoid disease in the upper cervical region.
The patient then underwent chemotherapy,
and total spine magnetic resonance (MR) imaging 2 months later
demonstrated stability in the size of the spinal cord tumor and a
decrease in the associated syrinx.
However, an MR image of the head
demonstrated two new areas of supratentorial subarachnoid
leptomeningeal spread of the primary spinal cord tumor at the 2-month
follow-up examination.
At the 6-month follow-up examination, MR
imaging of the head and spine demonstrated stable metastatic
disease.
This case illustrates a unique instance of
supratentorial leptomeningeal dissemination of an intramedullary
spinal cord PCA in a child.
Keywords: pilocytic astrocytoma, leptomeningeal
dissemination, glioma, recurrent disease, pediatric neurosurgery
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Copyright 2006 by American Association
of Neurological Surgeons
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Abstract
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