Recurrence Of Pilocytic Astrocytoma Of The Sellar Region With Intraventricular Growth: Clinical Case And Improvement Of Objective Vision

Abstract

Introduction/Background: Pilocytic astrocytoma (PA) rarely originates in the sellar region. Tumor recurrence with intraventricular extension represents a complex neurosurgical scenario because of the proximity to the optic apparatus and the risk of persistent or progressive visual dysfunction.

Case presentation: An 11-year-old patient with a history of subtotal resection of a sellar pilocytic astrocytoma presented with tumor recurrence three years after the initial surgery, with intraventricular growth on magnetic resonance imaging (MRI). After the first procedure, the patient developed severe visual impairment and diabetes insipidus. Preoperative functional assessment included visual evoked potentials (VEP), which demonstrated delayed conduction along the visual pathways, suggesting compromised but potentially reversible pathway function. The patient underwent repeat surgical treatment via craniotomy with transcortical transventricular tumor resection, aiming at decompression of the visual pathways and maximal safe removal of the recurrent lesion. Postoperatively, gradual functional improvement was observed, including recovery of objective vision characterized by improved ability to perceive details and to discriminate the shape and movement of objects. However, limitations in recognition of fine details persisted, consistent with residual pathway injury.

Conclusions: In recurrent sellar pilocytic astrocytoma with intraventricular extension, surgical reintervention and decompression may lead to meaningful visual functional recovery even after prolonged deficits. VEP constitutes a valuable adjunct for documenting visual pathway dysfunction and may help estimate the potential for postoperative visual improvement.