Intraventricular pilocytic astrocytoma in pediatric patient: A rare case report

Abstract: Intraventricular pilocytic astrocytomas (IVPAs) are uncommon, representing approximately 4%–15.6% of all pilocytic astrocytomas (PAs). This report aimed to outline the radiological characteristics, surgical strategy, and clinical outcome of a patient with a histopathologically confirmed IVPA. We report a rare case of a 14-year-old male diagnosed with an IVPA (World Health Organization (WHO)-Grade I). Although PAs are the most frequently encountered brain tumors in the pediatric population, their occurrence within the ventricular system is unusual and poses notable diagnostic and surgical challenges, especially when complicated by obstructive hydrocephalus resulting from secondary involvement of the tectal plate. Histopathological examination confirmed the diagnosis, revealing characteristic low-grade features including moderate hypercellularity, elongated piloid glial cells, and a microcystic stroma. Perivascular satellitosis further supported the glial origin of the tumor. The patient was successfully managed using a combined approach of neuronavigational-assisted microsurgical resection and endoscopic third ventriculostomy, underscoring the value of a multimodal surgical strategy for deep-seated intraventricular tumors. Owing to the WHO-Grade I classification and effective resolution of hydrocephalus, the patient’s long-term prognosis is highly favorable. This case contributes to the scarce literature on IVPAs in the Indian pediatric population and emphasizes the importance of including low-grade gliomas in the differential diagnosis of intraventricular masses in children.