Background: Intracranial pilocytic astrocytomas are rare glial tumors. In children, it is one of the most frequent brain tumors. These tumors are histologically benign. However, they do sometimes infiltrate the cerebral stem.

Methods and objectives: Through a descriptive retrospective study of 28 cases of cerebellar pilocytic astrocytomas of the children collected at our Department during a 12-year period, we aimed to report modern data on the anatomical and cytogenetic aspects of pilocytic astrocytomas, to present the epidemiological, clinical and radiological characteristics as well as the therapeutic modalities of these tumors in children through an analysis of the different cases of our series, aiming to identify the main prognostic factors of these tumors.

Results: Intracranial pilocytic astrocytomas represent 3.7% of all intracranial tumors and are more frequent in children. They account 28.8% of pediatric infratentorial tumors diagnosed during the same study period. The average age is 9.5 years. The sex ratio (M/F) was 2.5. Clinical signs were dominated by intracranial hypertension shown by all patients, papillary edema, cerebellar syndrome and vestibular syndrome. In imaging, vermian localization was the most frequent. The most frequently observed radiologic appearance was cystic lesion with a wall nodule, the purely fleshy form was found in 5 cases and the purely cystic form was found in one single case. Calcifications were noted in 7.1% of the cases. The treatment of cerebellar pilocytic astrocytomas of the child is surgical. The operative position was ventral in 28 cases. The invasion of the floor of the 4th ventricle constitutes the limiting factor of the excision in our series but the cerebral control MRI for patients surviving with a considered subtotal resection did not demonstrate a tumor residue. The mortality rate is 7.1%. After an average follow-up of 60 months, we observed only one case of recurrence (3.8%). Cerebellar syndrome was the most frequent postoperative afte reffect. The overall survival at 5 years is 100%.

Conclusion: The final aim of the treatment is to ensure a maximal healing with a minimal morbidity. Complete excision is not always possible. Clinical and radiological follow-up must be extended beyond the adulthood.