title: Cerebellar pilocytic astrocytoma in adults: a management paradigm for a rare tumour.
abstract: BACKGROUND
  Pilocytic astrocytoma is one of the commonest subtypes of glioma to affect children. However, they are rarely diagnosed in patients over the age of 18 years. In adults, these tumours appear more frequently supra-tentorially than in the cerebellum and some reports suggest a different clinical course in adults. We reviewed ten patients aged 18 or over who had been operated on for cerebellar pilocytic astrocytoma to assess the impact of tumour biology and extent of resection on outcome in adults.
  
  
  METHODS
  Patients were identified from a neuropathology database and a retrospective chart review of ten patients was performed. Recorded data included patient demographics, tumour location, presenting features, radiological appearance, extent of surgical resection, tumour recurrence and Ki-67 proliferation index.
  
  
  RESULTS
  Nine patients were men and one patient was a woman. Median follow up is 41.5 months (range 15-334 months). Complete surgical resection was achieved in nine of the patients operated in our institution. One patient had prior subtotal resection elsewhere. Tumour recurrence was seen only in the two patients with subtotal resection, at 7 and 25 years. Ki-67 ranged from <1 to 10% and appears to have no correlation to recurrence. No patients in this series had adjuvant treatment.
  
  
  CONCLUSIONS
  Cerebellar pilocytic astrocytomas in adults should be treated with macroscopic complete surgical resection whenever possible. If this is achieved, long-term survival rates are excellent, whereas subtotal resection carries a high risk of tumour recurrence. Ki-67 is less important prognostically than the extent of initial resection.
authors.affiliation: Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
authors.forename: Antonia
authors.initials: A
authors.lastname: Wade
authors.forename: Caroline
authors.initials: C
authors.lastname: Hayhurst
authors.forename: Anthony
authors.initials: A
authors.lastname: Amato-Watkins
authors.forename: Alistair
authors.initials: A
authors.lastname: Lammie
authors.forename: Paul
authors.initials: P
authors.lastname: Leach
mesh_terms: D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen