Tumours of the posterior fossa intrinsic

MRI scanning is superior to CT scanning in the detection and evaluation of brain stem astrocytoma. -

BRAIN STEM ASTROCYTOMA

Rarely, astrocytomas arise within the brain stem. Most are of the fibrillary or pilocytic types and diffusely expand the pontine region although they can be malignant. They develop mainly in children or young adults. Clinical features

Cranial nerve palsies and long tract signs gradually develop as the tumour progresses. Eventually conscious level is impaired. More malignant gliomas are associated with a rapidly progressing course, often with signs of raised intracranial pressure.

Investigations

MRI scanning is superior to CT scanning in the detection and evaluation of brain stem astrocytoma. -

CT scan may show low density within the brainstem, with absence of surrounding cisterns and posterior displacement of the 4th ventricle _

Management

Operative exploration is rarely indicated. Radiotherapy is often administered, usually after a stereotactic biopsy, with occasional palliation of symptoms and uncertain effect on survival. Chemotherapy is of no value.

Prognosis

At best, the 5-year survival following radiotherapy is 35%. Rarely, patients may survive for up to 20 years with minimum disability.

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