Pylocytic Astrocytoma of the Inferior Trigone of the Fourth Ventricle Fundus: Peculiarities of a Clinical Course and the Nearest Result of Surgical Treatment

Kamalova G.M., Kondyukov D.A.

(Polenov Research Neurosurgical Institute)

Male patient T. was treated in the Neurooncologic Department. The diagnosis was as follows: pylocytic astrocytoma of the inferior trigone of the fourth ventricle fundus; a state after resection trephination of the posterior cranial fossa and subtotal removal of the tumor.

The patient had no complaints at the moment of examination. He told of two previous episodes of paroxysmal headache with speech disturbances and vomiting at the end of attacks.

The first manifestation of the disease (1998) was headache, which occurred after physical load. It was accompanied by elements of motor aphasia and ended in vomiting. The second analogous episode happened on August 29, 2001. The patient felt well between the episodes.

On admission his state was stable, compensated (the score of 90 according to Karnovsky's Scale). There were no focal neurologic symptoms and signs of intracranial hypertension on neurologic examination.

Ophthalmologic examination showed mild myopia. MRI with a contrast substance (September 9, 2001) revealed a tumor, localized on a dorsal surface of the medulla oblongata and spreading from the cerebellar tonsils up to the great foramen margin.

The operation was performed on September 28, 2001. In consisted in inferior-median suboccipital craniotomy and subtotal removal of astrocytoma of the fourth ventricle fundus (Prof. Tigliev G.S.). Intraoperative electroencephalographic monitoring and control of evoked stem potentials were used.

Histologic examination (N 2370/75-01) was indicative of pylocytic astrocytoma with moderate polymorphism of nuclei and proliferation of vascular endothelium.

There were no peculiar neurologic symptoms on discharge. A general state was stable and compensated (the score of 90 according to Karnovsky's Scale).

There were the following peculiarities:

  1. Hydrocephalic-hypertensive crises were accompanied by elements of motor aphasia.
  2. Absence of focal and hypertensive symptoms between attacks.
  3. Rare hypertensive crises in considerable dimensions of the tumor, causing marked triventricular hydrocephalus.
  4. Absence of any changes on the eye fundus against a background of marked hydrocephalic changes.

The demonstration goal:

To show peculiarities of a clinical course of astrocytoma of this localization and possibility of its almost total removal.