History of Management of Cerebellar Astrocytomas in Children

Understanding of Disease

  • Pathological grading gives accurate prognosis: With modern pathological classification of brain tumors has come the understanding that the majority of cerebellar astrocytomas in children are pilocytic astrocytomas, W.H.O. grade I, with an excellent prognosis after surgical resection alone (3, 4).
  • Small residual disease typically dormant: Management of residual and recurrent tumors remains controversial, but with time has come the understanding that small residual tumors may be stable over a period of many years, and observation can be a reasonable treatment approach (3).

Technological Development

  • Accurate radiological predictors of disease in cyst walls: The introduction of CT scanning and then of MRI has allowed the correlation of imaging studies and pathological analysis of tumor samples, which in turn has led to the understanding of what constitutes tumor on imaging. In particular, it is now understood that when a cyst wall has thin enhancement, it likely represents compressed cerebellum rather than neoplasia and does not need to be resected surgically (16).