Prognosis of cerebellar astrocytomas in children

Abstract

Our main objective is to review a large series of cerebellar astrocytomas in children and evaluate the outcome of the patients depending on astrocytoma class. The effect of astrocytoma characteristics on the children's prognosis was determined by grouping a series of cerebellar astrocytomas by their location, radiological aspect, size, and histology and determining whether this was related with outcome. Two hundred and three children with cerebellar astrocytomas were retrospectively reviewed, and their tumors were classified by location, macroscopic radiological appearance, size, and histology. We have distinguished between patients operated before and after 1974 because of the introduction of new diagnostic (computed tomography, magnetic resonance) and more sophisticated treatment techniques after this year (microsurgery, laser, cavitron, etc). Our patients' results were classified according to the Lapras scale/classification as normal, with some neurological deficit but able to lead a normal life, and those with severe post surgical deficits. Recurrences and mortality were also noted. Normal or good results were obtained in 111 patients, some neurological deficit in 55, and severe deficits in nine. There were six recurrences and 22 deaths because of the disease. Two main factors affected prognosis. One was whether the tumor was completely resected or not; this was the treatment in most cases in this series. The second factor was the location, size, and macroscopic appearance of the tumor. The best prognosis was associated with being located in one hemisphere, being cystic, being cystic with a posterior nodule, and/or being small.