{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T16:41:18Z","timestamp":1760546478070,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pilocytic astrocytoma (PCA) are commonly observed as slow-growing noncancerous brain tumors in pediatric populations, but they can also occur in adults, albeit rarely. When located in diencephalic regions, particularly in the hypothalamus, they present unique diagnostic and management challenges due to their rarity and overlapping clinical and radiological features with other intracranial pathologies. This systematic review aims to provide a comprehensive understanding of hypothalamic PCA in adults, focusing on their differential diagnosis, neurological presentation, diagnostic modalities, treatment strategies. A case illustration is also described in order to better underline all the difficulties related to the diagnostic process. Material and methods: A systematic literature search was conducted in the PubMed\/MEDLINE, Embase, and Scopus databases up to November 2023 to identify studies. Results: The systematic literature search identified a total of 214 articles. Following screening by title and abstract and full-text review, 12 studies were deemed eligible and are included here. Conclusions: Adult-onset PCA in diencephalic regions pose diagnostic challenges due to their rarity and overlapping features with other intracranial lesions. Advanced imaging techniques play a crucial role in diagnosis, while surgery remains the cornerstone of treatment. Multidisciplinary collaboration is essential for the optimal management and long-term follow-up of these patients.<\/jats:p>","DOI":"10.3390\/jcm13123536","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T06:29:43Z","timestamp":1718605783000},"page":"3536","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hypothalamic Hemangioma-like Pilocytic Astrocytoma in an Adult Patient: A Systematic Review with a Focus on Differential Diagnosis and Neurological Presentation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3215-7179","authenticated-orcid":false,"given":"Roberta","family":"Costanzo","sequence":"first","affiliation":[{"name":"Neurosurgical Clinic, AOUP \u201cPaolo Giaccone\u201d, Post Graduate Residency Program in Neurology Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittoria","family":"Rosetti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Neurological Sciences of Bologna, 40124 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Tomassini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dalila","family":"Fuschillo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Lofrese","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico Gerardo","family":"Iacopino","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, AOUP \u201cPaolo Giaccone\u201d, Post Graduate Residency Program in Neurology Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigino","family":"Tosatto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, M. Bufalini Hospital, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1093\/neuonc\/nou223","article-title":"CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2007\u20132011","volume":"16","author":"Ostrom","year":"2014","journal-title":"Neuro Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1080\/02688690400022896","article-title":"Pilocytic astrocytoma of the adult\u2013clinical features, radiological features, and management","volume":"18","author":"Bell","year":"2004","journal-title":"Br. J. Neurosurg."},{"key":"ref_3","unstructured":"Knight, J., and De Jesus, O. (2024). Pilocytic Astrocytoma. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s00401-015-1410-7","article-title":"Pilocytic astrocytoma: Pathology, molecular mechanisms, and markers","volume":"129","author":"Collins","year":"2015","journal-title":"Acta Neuropathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.wneu.2017.11.102","article-title":"Adult Pilocytic Astrocytoma: An Institutional Series and Systematic Literature Review for Extent of Resection and Recurrence","volume":"110","author":"Bond","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"CNS68","DOI":"10.2217\/cns-2020-0027","article-title":"Adult pilocytic astrocytoma in the molecular era: A comprehensive review","volume":"10","author":"Gregory","year":"2021","journal-title":"CNS Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/B978-0-12-802997-8.00020-7","article-title":"Pilocytic astrocytomas","volume":"Volume 134","author":"Bornhorst","year":"2016","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00234-018-1991-7","article-title":"Usefulness of perfusion- and diffusion-weighted imaging to differentiate between pilocytic astrocytomas and high-grade gliomas: A multicenter study in Japan","volume":"60","author":"Kikuchi","year":"2018","journal-title":"Neuroradiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1148\/radiology.189.1.8372197","article-title":"Neuroimaging of juvenile pilocytic astrocytomas: An enigma","volume":"189","author":"Fulham","year":"1993","journal-title":"Radiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/XEB.0000000000000054","article-title":"Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data","volume":"13","author":"Munn","year":"2015","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/19439342.2012.710641","article-title":"Narrative approaches to systematic review and synthesis of evidence for international development policy and practice","volume":"4","author":"Snilstveit","year":"2012","journal-title":"J. Dev. Eff."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/BF01476493","article-title":"Analysis of 20 primarily surgically treated chiasmatic\/hypothalamic pilocytic astrocytomas","volume":"126","author":"Valdueza","year":"1994","journal-title":"Acta Neurochir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"849","DOI":"10.2176\/nmc.37.849","article-title":"Hypothalamic Pilocytic Astrocytoma Presenting with Intratumoral and Subarachnoid Hemorrhage","volume":"37","author":"Matsumoto","year":"1997","journal-title":"Neurol. Med.-Chir."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"484","DOI":"10.3171\/jns.2000.93.3.0484","article-title":"Involution of diencephalic pilocytic astrocytoma after partial resection. Report of two cases in adults","volume":"93","author":"Balkhoyor","year":"2000","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1227\/01.NEU.0000249211.89096.25","article-title":"Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: Part 2","volume":"60","author":"Cavallo","year":"2007","journal-title":"Neurosurgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1055\/s-0028-1119414","article-title":"Extended Endoscopic Endonasal Approach to the Skull Base","volume":"52","author":"Arbolay","year":"2009","journal-title":"MIN-Minim. Invasive Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1055\/s-0031-1280682","article-title":"Endoscopic Endonasal Infrasellar Approach to the Sellar and Suprasellar Regions: Technical Note","volume":"21","author":"Paluzzi","year":"2011","journal-title":"Skull Base"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2014.7.FOCUS14317","article-title":"Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: Preliminary report","volume":"37","author":"Zoli","year":"2014","journal-title":"Neurosurg. Focus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"707.e17","DOI":"10.1016\/j.wneu.2016.03.035","article-title":"Hypothalamic\u2013Optochiasmatic Pilocytic Astrocytoma Associated with Occipital and Sacral Spinal Cavernomas: A Mere Coincidence or a True Association?","volume":"90","author":"Raheja","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.3171\/2017.12.JNS172188","article-title":"Regression after subtotal resection of an optic pathway glioma in an adult without adjuvant therapy: Case report","volume":"130","author":"Hidalgo","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00381-018-3994-4","article-title":"Endoscopic transnasal resection of optic pathway pilocytic astrocytoma","volume":"35","author":"Albakr","year":"2019","journal-title":"Child\u2019s Nerv. Syst. ChNS Off. J. Int. Soc. Pediatr. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2176\/nmc.oa.2019-0208","article-title":"Frequent Clinical and Radiological Progression of Optic Pathway\/Hypothalamic Pilocytic Astrocytoma in Adolescents and Young Adults","volume":"60","author":"Shoji","year":"2020","journal-title":"Neurol. Med.-Chir."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhou, Z.-Y., Wang, X.-S., Gong, Y., Musyafar, O.L.A., Yu, J.-J., Huo, G., Mou, J.-M., and Yang, G. (2021). Treatment with endoscopic transnasal resection of hypothalamic pilocytic astrocytomas: A single-center experience. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01113-6"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s11060-020-03513-9","article-title":"Clinical characteristics and prognostic factors of adult patients with pilocytic astrocytoma","volume":"148","author":"Mair","year":"2020","journal-title":"J. Neuro-Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1177\/0883073820937225","article-title":"Pilocytic Astrocytoma: A Review of General, Clinical, and Molecular Characteristics","volume":"35","author":"Salles","year":"2020","journal-title":"J. Child Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"197","DOI":"10.5114\/fn.2016.62530","article-title":"Heterogeneity of histopathological presentation of pilocytic astrocytoma\u2013diagnostic pitfalls. A review","volume":"3","author":"Matyja","year":"2016","journal-title":"Folia Neuropathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e380","DOI":"10.1227\/ons.0000000000000614","article-title":"Endoscopic Endonasal Transcavernous Posterior Clinoidectomy with Interdural Pituitary Transposition for a Suprasellar Optic Pathway Pilocytic Astrocytoma: 2-Dimensional Operative Video","volume":"24","author":"Nair","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1093\/neuonc\/noac241","article-title":"The clinical and molecular characteristics of progressive hypothalamic\/optic pathway pilocytic astrocytoma","volume":"25","author":"Li","year":"2023","journal-title":"Neuro-Oncology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.neuchi.2017.04.002","article-title":"Pilocytic astrocytoma mimicking cavernous angioma: Imaging features and histological characteristics","volume":"63","author":"Gaha","year":"2017","journal-title":"Neurochirurgie"},{"key":"ref_31","first-page":"524574","article-title":"A Pilocytic Astrocytoma Mimicking a Clinoidal Meningioma","volume":"2014","author":"Hong","year":"2014","journal-title":"Case Rep. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1308\/003588412X13171221588811","article-title":"Pilocytic astrocytoma mimicking craniopharyngioma: A case series","volume":"94","author":"Skipworth","year":"2012","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/02688697.2017.1419163","article-title":"Pilocytic astrocytoma of the cerebellopontine angle mimicking vestibular schwannoma: Report of a rare entity","volume":"34","author":"Dutta","year":"2020","journal-title":"Br. J. Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s00381-016-3262-4","article-title":"MR imaging of pilocytic brain astrocytoma: Beyond the stereotype of benign astrocytoma","volume":"33","author":"Gaudino","year":"2017","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/RCT.0b013e3181d77d52","article-title":"Magnetic Resonance Imaging Features of Pilocytic Astrocytoma of the Brain Mimicking High-Grade Gliomas","volume":"34","author":"Kumar","year":"2010","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.neurad.2014.09.001","article-title":"Pilocytic astrocytoma presenting with atypical features on magnetic resonance imaging","volume":"42","author":"Nakano","year":"2015","journal-title":"J. Neuroradiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3968","DOI":"10.1007\/s00330-018-5706-6","article-title":"Differentiation between pilocytic astrocytoma and glioblastoma: A decision tree model using contrast-enhanced magnetic resonance imaging-derived quantitative radiomic features","volume":"29","author":"Dong","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.mri.2022.12.013","article-title":"Differentiation of Pilocytic Astrocytoma from Glioblastoma using a Machine-Learning framework based upon quantitative T1 perfusion MRI","volume":"98","author":"Vats","year":"2023","journal-title":"Magn. Reson. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3171\/ped.2006.104.5.314","article-title":"Vascularity and angiogenesis as predictors of growth in optic pathway\/hypothalamic gliomas","volume":"104","author":"Bartels","year":"2006","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"789856","DOI":"10.3389\/fonc.2022.789856","article-title":"Epidemiology and Survival of Patients with Optic Pathway Gliomas: A Population-Based Analysis","volume":"12","author":"Liu","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"109946","DOI":"10.1016\/j.ejrad.2021.109946","article-title":"A diagnostic tree for differentiation of adult pilocytic astrocytomas from high-grade gliomas","volume":"143","author":"Park","year":"2021","journal-title":"Eur. J. Radiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3536\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:59:52Z","timestamp":1760108392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,17]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13123536"],"URL":"https:\/\/doi.org\/10.3390\/jcm13123536","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,6,17]]}}}