Astrocytomas of the cerebral peduncle in children: surgical experience in seven patients.

OBJECTS: Cerebral peduncle tumors are rare in childhood but often consist of benign astrocytomas. Surgical resection, however, is considered to be detrimental because of the highly sensitive neural structures. These tumors are often treated by radiation therapy (RT). We resected such tumors in seven patients, whom we then followed up without adjuvant therapy. The surgical approach and postoperative course are analyzed.
METHODS: Seven children, ranging in age from 4 to 16 years, were treated from 1993 to 2000. Tumors showed extension in various directions to the thalamus, pons and neighboring cisterns. All were treated by surgical resection through a subtemporal approach: total resection was achieved in three and subtotal resection in four. Operative complications were minimal. Two patients were worse after surgery, albeit temporarily, in motor, oculomotor or memory functions. All the tumors were benign astrocytomas. None of the patients received postoperative RT. Only one patient had a recurrence during the follow-up period, which ranged from 1 year to 8.5 years in duration.
CONCLUSIONS: Benign astrocytomas of the cerebral peduncle are amenable to radical tumor resection by an appropriate surgical approach and with microsurgical techniques. Even following subtotal resection, these tumors frequently remain stable or involute. These children can be spared RT.