Pilocytic astrocytoma

Case contributed by Dr Bahman Rasuli

Presentation

Headache, vision loss, and increased intracranial pressure.

Patient Data

Age: 15 years
Gender: Male
MRI

Suprasellar ovoid solid mass with water restriction on DWI images and heterogeneous enhancement measuring about 30*45*50 mm with superior extension toward the third ventricle causing to dilatation of lateral ventricles and subependymal spillages

Posterior extension of the mass causing marked pressure and deformity of the midbrain and cerebral peduncles and involvement of interpeduncular cistern

Anterior extension causing to pressure effect on Willis circle and anterior displacement of ACA and ACOM arteries

No vasogenic edema

The normal pituitary gland in a normal sella 

High signal foci in T2 and flair sequences at subcortical white matter of the right parietal lobe depict microvascular ischemic event.

Photo

This was a histo-pathologically proven case of pilocytic astrocytoma.

Case Discussion

Pilocytic astrocytomas represent the most common childhood brain tumors, frequently in the cerebellar region

The recent case shows a less common location in the optic pathway, which is seen in about 20% to 30% of cases

Surgical resection is the treatment of choice with radiation and chemotherapy for optic and hypothalamic region tumors

In this case, suprasellar germinoma and craniopharyngioma were in the differential diagnosis.

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