Holocord intramedullary pilocytic astrocytoma mimicking holocord spinal abscess: a case report and literature review.

Abstract

Purpose: This report aims to present a case of a child with holocord pilocytic astrocytoma and review the existing literature to provide insights into current management strategies.

Case presentation: An 11-month-old patient presented with progressive quadriplegia and was initially diagnosed with a spinal abscess. MRI revealed a heterogeneously enhancing cystic intramedullary lesion extending from the cervicomedullary region to the conus medullaris. The patient underwent an emergent T10-L1 total laminectomy and midline myelotomy for presumed abscess drainage. Intraoperative findings, however, were inconsistent with an abscess, suggesting a neoplastic process. Postoperative MRI indicated persistent spinal cord compression and histopathological examination showed no leukocytes or microorganisms. A second surgery the following day extended the laminectomy to T3, achieving gross total resection. Pathology confirmed a grade I pilocytic astrocytoma. Given the patient's age, chemotherapy with vincristine and carboplatin was initiated, as radiotherapy was unsuitable. Early physical therapy was commenced, resulting in significant neurological improvement to 4/5 muscle strength in all extremities according to the Medical Research Council (MRC) scale in the first year. Chemotherapy was discontinued due to systemic complications. At the 1-year follow-up, MRI demonstrated no tumor recurrence.

Conclusion: The management of holocord pilocytic astrocytomas presents significant challenges, particularly in pediatric patients. While surgical resection remains the cornerstone of treatment, the role of chemotherapy requires further investigation. This case underscores the necessity of a multidisciplinary approach and highlights the potential for favorable outcomes with appropriate intervention.