Abstract
BACKGROUNDTreatment of pilocytic astrocytomas (PAs) in children can be challenging when they arise in deep midline structures because complete surgical resection may result in significant neurological injury. Laser interstitial thermal therapy (LITT) has provided an alternative treatment modality for lesions that may not be amenable to resection. However, many patients with PAs may be symptomatic from a compressive cyst associated with the PA, and LITT does not obviate the need for cystic decompression in these patients.OBSERVATIONSA 12-year-old male presented with left-sided weakness. Magnetic resonance imaging (MRI) revealed an enhancing mass with a large cyst involving the right thalamus and basal ganglia. The patient underwent a reservoir placement for cyst drainage and biopsy of the mass, revealing a pilocytic astrocytoma. He then underwent LITT followed by adjuvant chemotherapy. Sixteen months after LITT, follow-up MRI of the brain revealed no tumor growth.LESSONSThis is the first case to describe reservoir placement to treat the cystic portion of a pilocytic astrocytoma followed by LITT and targeted chemotherapy. Reservoir placement reduced the cyst’s mass effect and resolved the patient’s symptoms, allowing for treatment options beyond resection.
Highlights
Treatment of pilocytic astrocytomas (PAs) in children can be challenging when they arise in deep midline structures because complete surgical resection may result in significant neurological injury
Cell death is dependent on thermal intensity and duration but generally begins at 40°C to 50°C.7. One advantage of this modality is that it allows for magnetic resonance imaging (MRI) for stereotactic spatial orientation of the ablating source as well as real-time thermoablation monitoring with Magnetic resonance imaging (MRI) thermometry during the procedure
We present the case of a young male with left-sided weakness from a PA of the right thalamus and basal ganglia with a large cyst causing significant mass effect in whom reservoir placement was used to reduce mass effect and alleviate symptoms, followed by Laser interstitial thermal therapy (LITT)
Summary
Treatment of pilocytic astrocytomas (PAs) in children can be challenging when they arise in deep midline structures because complete surgical resection may result in significant neurological injury. The patient underwent a reservoir placement for cyst drainage and biopsy of the mass, revealing a pilocytic astrocytoma He underwent LITT followed by adjuvant chemotherapy. Cell death is dependent on thermal intensity and duration but generally begins at 40°C to 50°C.7 One advantage of this modality is that it allows for magnetic resonance imaging (MRI) for stereotactic spatial orientation of the ablating source as well as real-time thermoablation monitoring with MRI thermometry during the procedure. We present the case of a young male with left-sided weakness from a PA of the right thalamus and basal ganglia with a large cyst causing significant mass effect in whom reservoir placement was used to reduce mass effect and alleviate symptoms, followed by LITT
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