gms | German Medical Science

Objective: Pilocytic astrocytomas are normally termed as benign and after total resection curable diseases. We report a case with a very different clinical course.

Results: A 30-years-old woman suffered from an intrinsic spinal tumour in 2001. The tumour was located in the thoracic region. A subtotal resection was performed. Apart from minor sensitivity deficits of one leg, she lived independently initially after the operation. Histological examination of the removed tissue doubtlessly revealed a pilocytic astrocytoma. However not longer than one year after the initial intervention a regrowth of the tumour at the same location occurred. Consequently another subtotal excision was performed and, - due to the uncommon biological behaviour -, an irradiation of the thoracic spinal cord of 30 Gy was added. Despite this however, a fast regrowth of the tumour at his initial location and first hints of a spread along the spinal subarachnoid space became obvious in early 2003. In parallel with these findings first signs of a hydrocephalic condition occurred. Several cycles of different chemotherapy regimes followed to delay a further tumour spread. In 2004 the whole spinal subarachnoid space was filled out with tumour and the intrinsic part of the tumour has been enlarged substantially. To control the hydrocephalic condition a Rickham reservoir has been inserted at this time. For about one year it was sufficient to remove about 40 ml CSF once a month. In 2005 the patient became paraplegic and more and more signs of generally increased ICP occurred despite intermitted and increasingly often CSF removal. MRI at that time revealed a massive meningeal tumour spread within the cranial subarachnoid space and a massive hydrocephalus leading to intractable headache. Finally, - under a palliative aspect -, a CSF shunt, which has been avoided prior because of some concerns to spread this biologically aggressive tumour outside the CSF space, has been inserted to treat hydrocephalus. Because of the large CSF pathway dimensions a Miethke PRO-GAV has been chosen. It has to be stressed that tumour cells could be found regularly at every taken CSF sample and according to histopathological criteria the tumours had to be classified as a pilocytic astrocytoma furthermore.

Conclusions: As to our knowledge this is the first report of a cranial spread along the CSF pathways of a primarily thoracically located pilocytic astrocytoma, which could not be prevented by irradiation and different aggressive chemotherapy regimes.