Abstract
The aim of this study was to analyze the various midline structures having preponderance
for astrocytoma, their incidence, clinical features, operative approach, prognosis,
and outcomes in children. It is a retrospective analysis of 152 cases with midline
astrocytic tumors in children admitted between January 1995 and December 2012 in the
Department of Neurosurgery at Sanjay Gandhi Postgraduate Institute of Medical sciences
Lucknow, India. The mean age of the cases with midline astrocytic tumors was 9.29 ± 4.56
years. Majority of these tumors occurred in the age group of 6 to 10 years (n = 58, 38.16%), with male to female ratio being 1.66:1. Out of 152 cases, tumors located
at midline cerebellum constituted majority of the cases (n = 38, 25%) followed by brain stem (n = 28, 18.42%), thalamic region (n = 24, 15.79%), corpus callosum (n = 18, 11.82%), pineal region (n = 12, 7.89%), optic nerve (n = 12, 7.89%), chiasmo-hypothalamic (n = 10, 6.58%), and septum pellucidum astrocytomas (n = 10, 6.58%). Majority of these tumors were of low-grade type (n = 136, 89.47%), and pilocytic astrocytomas were the commonest subtypes. Out of 152
cases, 136 (89.47%) cases had improved outcomes, 8 (5.26%) remained as they were in
preoperative state, and mortality was seen in 8 (5.26%) of the cases at 3 to 77 months
(mean 26.70 ± 9.70) of follow-up. Midline structures having preponderance for astrocytomas
were midline cerebellum, brain stem, thalamus, corpus callosum, pineal region, optic
nerve, chiasmo-hypothalamic, and septum pellucidum. Cerebellum was the commonest site.
Most of these astrocytomas were of low grade with pilocytic astrocytoma being the
commonest subtype. With meticulous presurgical planning, most of these tumors have
good outcome with significant reduction in mortality and morbidity.
Keywords
Midline - astrocytoma - histopathology - children - distribution - outcomes
