Natural history of supratentorial low-grade astrocytoma: Case report

Low-grade astrocytomas comprise a group of primary brain neoplasms with relatively low anaplastic potential, although through time they tend to behave more aggressively. They have a very heterogeneous natural course and clinical behavior. This report presents a natural history of a patient with low grade astrocytoma. A 32-year-old male sustained head injury after grand mal seizure. On admission, he was conscious and without neurological deficit. Initial computerized tomography and magnetic resonance of brain revealed oval, 4 cm in diameter, lesion in the left parietal region that was considered as low-grade glioma. The patient refused surgery. Eight years and four months later, he was readmitted. This time, he was subcomatose with right hemiplegia. Repeated computerized tomography showed huge tumor in the left frontoparietal region at the site of previous lesion. Urgent left frontoparietal craniotomy and reduction of tumor were performed. The patient recovered after surgery. Right hemiparesis remained. The described patient with low-grade astrocytoma lived without any oncological treatment eight years and four months from the time when diagnosis was made until intracranial herniation. The natural history of disease in presented patient indicated that rational therapeutic strategy, for low-grade astrocytoma with epilepsy only, would be deferral of surgery until the time of manifestation of neurological or radiological deterioration.