Pilocytic astrocytoma presenting as an intrinsic brainstem tumor: case report and review of the literature.

OBJECTIVE

Pilocytic astrocytomas are typically circumscribed, slow growing tumors found in children and young adults. This type of tumor can arise from various locations in the neuraxis. In the brainstem, pilocytic astrocytomas grow as dorsal exophytic masses. To our knowledge, pilocytic astrocytomas arising entirely within the brainstem have not been reported in the literature.

CLINICAL PRESENTATION: A 22-year-old man presented with double vision for three months. A neurological exam revealed a right sixth nerve palsy.

INTERVENTION: Magnetic resonance imaging revealed an intra-axial mass with a cystic center arising from within the brainstem. Intraoperative findings confirmed an intra-axial brainstem tumor. Histological analysis revealed that the tumor was a low-grade glioma most consistent with a pilocytic astrocytoma.

CONCLUSION

This case report confirms that pilocytic astrocytomas can present as brainstem gliomas, and histopathology plays a major role in determining the aggressiveness of operative intervention.