Management of pediatric cervicomedullary astrocytoma

Abstract

Cervicomedullary astrocytomas are low grade gliomas of childhood and young age which are typically centered at the junction of brainstem and cervical spine and present with a long duration of symptoms. The diagnosis of cervicomedullary astrocytomas is normally delayed as these tumours are slow growing and patients present with a long duration of symptoms. The symptoms are typical and can be correlated to the location of the tumour. Histopathology and Immunohistochemistry(IHC) guides us proving the diagnosis. Management of cervicomedullary astrocytomas includes surgery, radiotherapy and chemotherapy. A 13 years old female child presented with complaints of headache, vomiting, neck pain and progressive neck tilt. MRI of brain and cervical spine revealed moderate to significant expansile lesion in the dorsal aspect of lower medulla, cervicomedullary junction and the upper cervical cord upto C4-5 disc level.She underwent subtotal resection of the tumour. Histopathology and IHC confirmed her diagnosis as Astrocytoma WHO Grade-II. Patient underwent adjuvant radiation treatment to a radiation dose of 54 Grey in 27 fractions by Volumetric modulated arc therapy(VMAT) technique over a period of 6 weeks to the gross residual tumour and post-op tumour bed. Patient tolerated the treatment well. Patient experienced mild symptoms like nausea and vomiting during the course of treatment but well managed with supportive medications.