Thoracolumbar pilomyxoid astrocytoma concomitant with spinal scoliosis: A case report and literature review

BACKGROUND: Pilomyxoid astrocytoma (PMA) is a variant of pilocytic astrocytomas but exhibits more aggressive behavior. Further, it is more prevalent in the hypothalamic/chiasmatic regions and is only rarely encountered in the thoracic spine. CASE DESCRIPTION: A 9-year-old male presented with severe spastic paraparesis (motor/sensory) attributed to a thoracic cord PMA and scoliosis. The magnetic resonance (MR) showed an intraaxial ill-defined expansile lesion with heterogeneous enhancement extending from the cervicothoracic junction to conus medullaris. A multilevel decompressive laminectomy was performed with restricted tumor debulking; an expansile duraplasty was also effected. Two years later, the patient has moderately improved and has not shown any symptom progression. CONCLUSION: We recommend the early performance of a thoracic MR in children with idiopathic scoliosis presenting with the onset of a significant spastic paraparesis.