Isolated spinal pilomyxoid astrocytoma without brain involvement: Case report and literature review

Background: Pilomyxoid astrocytoma (PMA) is a rare tumor that generally occurs in the hypothalamic– chiasmatic region and is only rarely encountered in the spinal cord. To date, only 17 cases of isolated spinal PMA without brain involvement have been reported in the English literature. Case Description: We report the 18 th case of a solitary spinal PMA in a 3-year-old boy who presented with progressive motor deficit and torticollis. Magnetic resonance imaging revealed an intramedullary lesion extending from C7 to T5. Subtotal resection was performed under neurophysiological monitoring. Histopathological examination confirmed the diagnosis of PMA. The patient subsequently received adjuvant chemotherapy. At 1-year follow-up, clinical improvement was observed with no radiological progression. Conclusion: Isolated spinal PMA is a rare variant of pilocytic astrocytoma with potentially aggressive behavior. Given the limited number of reported cases, optimal management remains controversial. Longer follow-up and larger series are required to establish standardized treatment guidelines.