Systematic Review of WHO Grade 4 Astrocytoma in the Cerebellopontine Angle: The Impact of Anatomic Corridor on Treatment Options and Outcomes

Danielle D Dang; Andrew D Gong; John V Dang; Luke A Mugge; Seth Mansinghani; Mateo Ziu; Adam L Cohen; Nilesh Vyas

doi:10.1055/a-2172-7770

Systematic Review of WHO Grade 4 Astrocytoma in the Cerebellopontine Angle: The Impact of Anatomic Corridor on Treatment Options and Outcomes

J Neurol Surg Rep. 2023 Oct 16;84(4):e129-e139. doi: 10.1055/a-2172-7770. eCollection 2023 Oct.

Authors

Danielle D Dang¹, Andrew D Gong¹, John V Dang², Luke A Mugge¹, Seth Mansinghani¹, Mateo Ziu¹, Adam L Cohen³, Nilesh Vyas¹

Affiliations

¹ Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States.
² Department of Internal Medicine, Walter Reed Military Medical Center, Bethesda, Maryland, United States.
³ Department of Neuro-Oncology, Inova Schar Cancer Institute, Inova Health System, Fairfax, Falls Church, Virginia, United States.

Abstract

Background Despite advances in multimodal oncologic therapies and molecular genetics, overall survival (OS) in patients with high-grade astrocytomas remains poor. We present an illustrative case and systematic review of rare, predominantly extra-axial World Health Organization (WHO) grade 4 astrocytomas located within the cerebellopontine angle (CPA) and explore the impact of anatomic location on diagnosis, management, and outcomes. Methods A systematic review of adult patients with predominantly extra-axial WHO grade 4 CPA astrocytomas was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through December 2022. Results Eighteen articles were included comprising 21 astrocytomas: 13 exophytic tumors arising from the cerebellopontine parenchyma and 8 tumors originating from a cranial nerve root entry zone. The median OS was 15 months with one-third of cases demonstrating delayed diagnosis. Gross total resection, molecular genetic profiling, and use of ancillary treatment were low. We report the only patient with an integrated isocitrate dehydrogenase 1 (IDH-1) mutant diagnosis, who, after subtotal resection and chemoradiation, remains alive at 40 months without progression. Conclusion The deep conical-shaped corridor and abundance of eloquent tissue of the CPA significantly limits both surgical resection and utility of device-based therapies in this region. Prompt diagnosis, molecular characterization, and systemic therapeutic advances serve as the predominant means to optimize survival for patients with rare skull base astrocytomas.

Keywords: WHO grade 4 astrocytoma; brainstem glioma; cerebellopontine angle; glioblastoma; high-grade glioma; lateral skull base.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).