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However, due to the welldocumented late recurrence behavior of a small percentage of benign cerebellar astrocytomas, sometimes decades after GTR, clinical changes should warrant reimaging. STR requires closer serial neuroimaging due to higher rates of tumor recurrence. Diffuse/fibrillary histology (grade II) is associated with STRs, however, GTRs of this histological subtype seem to demonstrate prognosis and recurrence rates rivaling those of juvenile pilocytic cerebellar tumors (grade I). Regardless of the extent of resection, most practitioners tend to follow grade II lesions more closely with serial exams and neuroimaging.

Journal of the National Cancer Institute 90:1473–1479 Campbell JW, Pollack IF (1996) Cerebellar astrocytomas in children. Journal of Neuro-oncology 28:223–231 Castello MA, Schiavetti A, Varrasso G, Clerico A, Cappelli C (1998) Chemotherapy in low-grade astrocytoma management. Childs Nervous System 14:6–9 Chadderton RD, West CG, Schuller S, Quirke DC, Gattamaneni R, Taylor R, Schulz S (1995) Radiotherapy in the treatment of low-grade astrocytomas. II. The physical and cognitive sequelae. Childs Nervous System 11:443–448 Chamberlain MC (1997) Recurrent cerebellar gliomas: salvage therapy with oral etoposide.

Histologically, optic nerve gliomas demonstrate two different patterns of growth. In patients without NF1, progression tends to be confined to the optic nerve without significant involvement of the meninges. In patients with NF1, tumor cells invade the subarachnoid space causing proliferative fibroblastic response and meningothelial hyperplasia (Stern et al. 1980). Locally, hypothalamic and optic gliomas may extend laterally invading the perivascular space along the arteries of the circle of Willis, as well as posterior expansion toward the brainstem with rostral invagination into the third ventricle.

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