Intraventricular pilocytic astrocytomas: Radiology, surgical management and outcome in a series of 8 patients

Abstract

OBJECTIVE: Intraventricular pilocytic astrocytomas are a rare occurrence, accounting for approximately 4%-15.6% of all pilocytic astrocytomas.The aim of the study was to describe the radiology, surgical management and outcome in 8 patients with histopathologically proven intraventricular pilocytic astrocytoma (ivPA). MATERIALS AND METHODS: The study was conducted at the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi. Between January 2010 and August 2015, 8 patients with histopathologically proven ivPA were identified. The radiological images were obtained from picture archiving and communication system (PACS). Clinical and surgical details were obtained from the computerized discharge summaries, and operative notes, whereas follow up was obtained from the patient record section. RESULTS: There were 4 males and 4 females in the study. The mean age was 27.8 years (range 17-57). Headache with progressive loss of vision was the most common presentation. Duration of symptoms varied from 4 months to 2 years (mean 9.88 months). Except one patient, all patients with preoperative CT scan revealed calcifications in the lesion, with extensive calcification seen in 3 patients. All the tumors were predominantly hypointense on T1WI and iso to hyperintense on T2WI. Lesions in all patients showed heterogenous contrast enhancement on post gadolinium images. Mean blood loss in the series was 1969 ml (range 250 ml-4500 ml).There was one death in this series due to meningitis and septic shock. Other complications included-disseminated intravascular coagulation (DIC), intraventricular hemorrhage, subdural hygroma, hemiplegia and hyponatremia. Preoperative diagnosis of iv PA could not be made on the basis of clinical and radiologic profile in any of thecases. CONCLUSION: Intraventricular pilocytic astrocytomas are rare tumors and are difficult to diagnose in the preoperative period based on the radiologic profile alone. These tumors can be extremely vascular with potential for massive blood loss. These tumors can be associated with extensive calcification and the calcified tumors have less bleeding as expected. Preoperative radiologic diagnosis by keeping a high index of suspicion can help in better operative planning, reducing blood loss and improving postoperative outcomes.