Search

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. [ABSTRACT FROM AUTHOR]

Objective: The endoscopic transsphenoidal approach is commonly used for sellar and suprasellar pathologies. However, reaching above the diaphragma sella, especially for posterosuperior and retrocavernous orientation, still poses some challenges. We designed and developed a steerable tip suction cannula (STSC) that has distinct leverage for endoscopic resection of such pathologies., Methods: The entire suction cannula is made of stainless steel. The instrument consists of a handle, vacuum tube, suction tip bed, suction tip, finger knuckle, wire path, countersunk headpin, and isolated steel wire. The working principle of the product is to enable the surgeon to move the aspiration tip in the desired direction by steering the finger knuckle. Five cadaveric specimens fixed with the saturated salt solution were used to evaluate the instrument and obtain measurements., Results: In the straight position, the STSC aspirated 2.67% slower than the control aspirator tip and 13.24% faster than that at 30° angulation. Based on the CT measurements, the mean angulation of the instrument from the frontobasal axis was 38.3°. The mean distance from the frontobasal axis was 1.3 cm. The average angulation of the tip of the instrument in the cranium was 25.5°., Conclusion: The designed STSC might effectively resect large to giant pituitary adenomas, especially those with supradiaphragmatic extension. Its suction capability is comparable to that of conventional suction tubes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.