Spinal Astrocytoma Reported by Richard

Epidemiology and pathology Rare lesion (1/3 of spinal cord glioma, < Ependymomas) affect all age: mean 29 y/o Male (58%)> female Thoracic (67%) > cervical (49%) (usually span multiple spinal levels in adult, more holocord in children ) Classification: Low-grade > high-grade (10~15%) Young children: juvenile pilocytic Adult: fibrillary

Presentation Symptoms often last months before diagnosis Pain is the most common initial presentation: from local to redicular Sensory loss with parathesia or dysesthesias (uni-or bilateral) Spastic, and weakness loss of bowel and bladder function. (less common) Others: gait abnormality, torticolis, scoliosis…etc

Diagnostic image Plain X-ray: CT/myelography: have little place in the diagnosis of spinal cord astrocytomas: enlarged spinal canal, scoliosis…etc CT/myelography: Can demonstrate spinal cord widening but can’t differentiate. Only useful when MRI is contraindicated. Intraoperative Ultrasound: Asymmetric expansion of spinal cord with variable echogenicity.

Diagnostic image MRI: isointense or hypointense with the spinal cord on Tl weighted imaging, hyperintense on T2. Average involvement: 7 vertebral segmant Cyst (+) Usually eccentric (57%)

Treatment Surgical resection Radiotherapy

Outcome Low grade: High grade: Prognositic indicators: five-year survival of 57% High grade: Survival after surgery averages six months in adults and thirteen months in children Prognositic indicators: Age, the younger the more length of time to recur Preoperative neurological level

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