Spinal cord astrocytomas: Presentation, management, and outcome

Although advances in imaging and surgical instrumentation have improved the diagnosis and management of intramedullary spinal cord astrocytomas, they remain a great challenge to the clinician. Generally, these are infiltrating tumors that cannot be entirely resected. The pilocytic subtype, however, is similar to those astrocytomas occurring in the posterior fossa in that they usually occur in the pediatric age group, may be resected, and have a favorable prognosis. MRI with and without contrast is the imaging modality of choice. The functional outcome of surgery correlates well with the preoperative condition. The surgical objective is resection to the extent possible so as to allow preservation of function. Outcome correlates with histologic grade. Patients with low-grade astrocytomas have a worse prognosis that those with ependymomas. As is the case for intracranial astrocytomas, the outcome for high-grade astrocytomas is extremely poor.