[Immediate and remote results of treatment of cerebellar astrocytoma].

Cerebellar astrocytoma accounted for 10% of all brain tumours treated at the Department of Neurosurgery, Medical Academy in Cracow in the years 1946 to 1968. It accounted for 16.6% of all gliomas, and 57% of subtentorial gliomas. Table I shows the distribution of the tumour according to age groups. The male:female sex ratio was near 1.0. In 124 cases the tumour was situated in the cerebellar hemispheres and in 91 in the vermis. The present study is based on an analysis of 215 cases with 124 tumours in the hemispheres and 91 in the vermis. In the hemispheres 77.8% of astrocytomas had cavities, while 22.2% were solid. In the vermis 60.6% of the tumours had cavities and 39.4% had no cavities. Infiltration of the brain stem or adherence to the floor of the fourth ventricle are mentioned in the protocols of 19 operations. The most frequent tumour in childhood and adolescence was pilocytic astrocytoma, in adulthood fibrillary and protoplasmic astrocytomas prevailed. In 10 cases of the last mentioned variety evidence of anaplasia was found. In the first four years when all operations were performed under local analgesia or rectal general anaesthesia the operative mortality was 21.5%, and in the subgroup of 40 first cases it was even 25%. After introduction of endotracheal anaesthesia the operative mortality fell to 13%, and in the subgroup of 40 last cases it was 9%. Detailed data about follow-up observations are available in 93 cases. Thirteen of them were disabled because of complete or nearly complete loss of vision. Nine of them completed schools for the blind and work in gainful occupations ad two founded families. Three patients are completely disabled because of equilibrium disturbances and ataxia. Two children attended a special school. The remaining 85 patients regarded themselves as healthy. This group comprised 66 patients operated upon at the age from 2 to 14 years, 12 were treated at the age from 15 to 21 years and 7 above that age. Some of them had high school education, others were doing heavy manual work, and many others attended secondary or high schools. Among the female patients 13 were mothers who gave birth to 23 children. (Table I). The fates of our patients confirm the view that in most cases cerebellar astrocytoma is surgically curable. The limit of radical operation is finding of brain stem infiltration observed in about 11% of cases. Partial removal of the tumour does not protect against recurrence but in some cases symptom-free periods of many years' duration were reported.