"Four predominant imaging patterns of pilocytic astrocytoma have been described: (a) mass with a nonenhancing cyst and an intensely enhancing mural nodule, (b) mass with an enhancing cyst wall and an intensely enhancing mural nodule, (c) necrotic mass with a central nonenhancing zone, and (d) predominantly solid mass with minimal to no cystlike component. Although most cyst walls do not enhance, some may enhance intensely, even as much as the mural nodule; however, cyst wall enhancement is not necessarily indicative of tumor involvement . Beliefs vary among neurosurgeons regarding whether to resect the cyst itself in cases of pilocytic astrocytoma. Some advocate complete resection, others biopsy, and still others no resection . Removal of the cyst wall has not been linked with improved survival ."
Case submitted by
Dr MGK Murthy, Dr Sumer Sethi