Faculty Bibliography

Intramedullary spinal cord astrocytoma is a relatively uncommon neoplasm accounting for only 4% of central nervous system tumors in childhood (1-5). Over the past four years the authors have operated on 100 young patients with very extensive astrocytomas, many of which involve the entire length of spinal cord. This unusual series has provided us with a unique opportunity to study the biology of the tumor, the response to conventional surgical and radiation therapy, and to develop a surgical technique that permits gross total resection of the neoplasms

The authors describe their experience with an unusual postoperative syndrome of pseudobulbar palsy occurring a few days after the extirpation of large midline vermian/4th ventricular tumors in children. The patients had a delayed onset of supranuclear cranial nerve palsies associated with emotional incontinence and lability that resolved over several weeks to months. It is postulated that retraction pressure on the medial cerebellum and split vermis is the operative insult responsible for edema that subsequently tracked along fiber pathways in the middle and superior cerebellar peduncles into the upper pons and midbrain. Modifications of operative technique to eliminate the need for retraction are presented