Brain Surgery

Astrocytoma

Tumor developing from brain glial cells

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Neuro-Oncology: Brain Tumors

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What is this Condition?

Astrocytoma is a glial tumor originating from astrocyte cells in the brain. It ranges from Grade 1-4 according to WHO classification. Low-grade astrocytomas grow slowly, while high-grade ones are more aggressive.

Diagnosis Methods

Evaluated with MRI imaging and MR spectroscopy. Definitive diagnosis is made by pathological examination after surgical biopsy or resection.

Treatment Methods

Treatment varies by grade. Surgical resection may be sufficient for low-grade tumors. High-grade tumors require radiotherapy and chemotherapy after surgery.

Frequently Asked Questions About Astrocytoma

Q1.What is the difference between astrocytoma and glioblastoma?▼
Both originate from the brain's support cells, but their biological behaviors differ. Astrocytomas with IDH mutations typically progress more slowly and can be managed with monitoring and treatment over many years. Glioblastoma, by contrast, is a more rapidly progressive tumor evaluated under a separate category. Genetic analysis of the tissue sample distinguishes between these; therefore, these tests are important before initiating treatment.
Q2.What is IDH mutation and why is it important?▼
IDH is a genetic feature examined in tumor cells and is one of the most important markers in astrocytomas. Tumors carrying this mutation typically appear in younger patients, grow more slowly, and tend to respond better to treatment. For these reasons, IDH status plays an important role both in predicting the likely course of the tumor and in determining which treatment will be selected.
Q3.What is Vorasidenib (Voranigo) and for whom is it suitable?▼
Vorasidenib is an oral, once-daily targeted drug that crosses the blood-brain barrier well. It is used after surgery in slow-growing astrocytomas with IDH mutations and has proven effective in delaying tumor progression. It is generally well tolerated, and in some patients it may defer or eliminate the need for radiation and chemotherapy for a period. Suitability is determined on an individual basis.
Q4.What is done after surgery in slow-growing astrocytoma?▼
Options vary depending on the patient's condition. Some patients benefit from oral targeted therapy (vorasidenib). In low-risk patients, close surveillance (periodic MRI follow-up) may be appropriate, while higher-risk patients may require radiation and chemotherapy. The decision is made jointly by a team, taking into account genetic test results, age, and patient preference.
Q5.How is drug therapy selected in more rapidly progressing astrocytoma?▼
In these types, chemotherapy is typically added to radiation after surgery. Multiple suitable drug regimens exist; one may be superior in efficacy but have more side effects, while another may be better tolerated. The choice is determined by the patient's age, overall health, and preference.
Q6.Can astrocytoma cause seizures? Are seizures controlled after surgery?▼
Yes. Seizures are a common initial symptom, particularly in slow-growing astrocytomas located near the brain surface; sometimes seizures may be the only complaint for years, and the tumor is discovered incidentally on MRI obtained for another reason. Surgical removal of the tumor significantly improves seizure control in most patients. Patients are started on anti-seizure medications, which are typically continued for a period.
Q7.Can slow-growing astrocytoma transform into a more rapidly progressive tumor? How is it recognized?▼
Yes, there is a possibility that the tumor may enter a more aggressive phase over the years; in tumors with IDH mutations, this transformation is generally slower and occurs later. Signs of this transformation on MRI include rapid growth, new contrast enhancement not previously seen, increased mass effect on surrounding structures, and worsening symptoms (increased headaches or seizures, new neurological deficits). Regular MRI surveillance at defined intervals is therefore very important.
Q8.What is awake surgery (awake craniotomy) and for whom is it suitable?▼
Awake surgery is a specialized surgical technique used for tumors located near critical brain areas controlling speech and movement. During a specific portion of the procedure, the patient is gently awakened; speech and movement are tested to determine which brain areas must be preserved. This allows maximum tumor removal while protecting these vital functions. The patient experiences no pain during this process because brain tissue itself lacks pain sensation. It is suitable for patients who can cooperate and whose anxiety can be managed, and is safely performed in experienced centers.
Q9.What are the side effects of radiation therapy in astrocytoma? How are they managed?▼
Side effects are divided into early and late onset. Early effects (during treatment and the following weeks) may include fatigue, temporary hair loss, skin redness, and mild headache; these are usually mild and resolve over time. Late effects (months to years later) may include slowed thinking, memory problems, and hormonal changes depending on the radiation field; serious complications are rare. Modern, targeted radiation techniques, supportive cognitive programs, and regular monitoring help minimize these effects. Most patients tolerate radiation therapy well.
Q10.How is quality of life preserved in astrocytoma patients? What support is important?▼
Comprehensive support is important for preserving quality of life: seizure control with medication, regular and appropriate exercise (walking, swimming, etc.), balanced nutrition, supportive activities for memory and attention, psychological support (coping with anxiety and depression), family and social support, fatigue management through regular sleep, and physical therapy when needed. With today's treatment options, many patients can continue their daily activities, work, and social life.

References

  1. Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:657-668.
  2. Osborn AG, Hedlund GL, Salzman KL. Osborn's Brain: Imaging, Pathology, and Anatomy. 2nd ed. Elsevier; 2018:529-533.
  3. Quiñones-Hinojosa A, ed. Schmidek and Sweet Operative Neurosurgical Techniques. 7th ed. Elsevier; 2021:85-92.
  4. Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
  5. Mellinghoff IK, van den Bent MJ, Blumenthal DT, et al. Vorasidenib in IDH1- or IDH2-Mutant Low-Grade Glioma (INDIGO). N Engl J Med. 2023:589-601.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Astrocytoma (ICD-10: C71 Series) | Dr. Özgür AKŞAN