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Clinical characteristics and long-term surgical outcomes of spinal pilocytic astrocytoma: a report of twenty cases

  • Original Article - Tumor - Glioma
  • Published:
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Abstract

Background

Primary spinal pilocytic astrocytoma (PA) is an extremely rare low-grade astrocytoma with unclear natural history. The demographic characteristics, imaging features, and long-term surgical outcomes have not been clarified due to low prevalence and limited reports.

Methods

A retrospective review within a single institution between 2004 and 2018 of all patients with pathologically proven PA was conducted. Patient data including demographics, radiographic features, treatment modalities, and long-term outcomes were evaluated.

Results

Twenty consecutive patients were identified, and 16 (80%) were male patients, with a mean age at presentation of 29 ± 13 years. The lesion was primarily located in cervical (n = 10, 50%), thoracic (n = 7, 35%), cervico-thoracic junction (n = 2), and lumbar level (n = 1, 5%). The tumor had a mean extension of 4 ± 2 (1–7) vertebral segments. Most PAs were located eccentrically (n = 16, 80%), with most being heterogeneous in appearance (cystic and solid) or purely cystic (n = 14, 70%), and had unclear margins (n = 16, 80%). Eleven patients (55%) had associated syringomyelia. Gross total resection (GTR) was achieved in 11 (55%) patients, and subtotal resection (STR) in 9 (45%). During a mean follow-up of 104 ± 56 months, 2 patients died and recurrence was found in 4 patients (20%), translating to a mean progression-free survival of 21 ± 11 months.

Conclusion

Primary spinal PA is a rare entity with acceptable progression-free survival if treated appropriately. Surgical resection may provide reasonable prolongation of survival, and GTR should be achieved if possible. A close follow-up is recommended especially for residual lesions, and a further in-depth investigation of molecular biomarkers is needed to stratify risk and prognostic factors.

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Author notes

  1. Liang Zhang and Teng Li contributed equally to this work.

Authors and Affiliations

  1. Medical School of Nankai University, No. 94, Weijin Road, Naikai District, Tianjin, 300071, People’s Republic of China

    Liang Zhang & Xinguang Yu

  2. Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China

    Liang Zhang, Teng Li, Guangyu Qiao, Aijia Shang & Xinguang Yu

  3. Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Wuyang Yang

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  1. Liang Zhang
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Correspondence to Xinguang Yu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee by the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Tumor - Glioma

The hospital in the article refers to the Chinese PLA General Hospital

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Zhang, L., Li, T., Qiao, G. et al. Clinical characteristics and long-term surgical outcomes of spinal pilocytic astrocytoma: a report of twenty cases. Acta Neurochir 163, 3005–3013 (2021). https://doi.org/10.1007/s00701-020-04606-0

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  • DOI: https://doi.org/10.1007/s00701-020-04606-0

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