OBJECTIVE: To investigate the clinical characteristics and treatment of spinal astrocytoma combined with severe scoliosis METHODS: A case review of 2 cases of spinal astrocytoma combined with severe scoliosis was performed, and the clinical characteristics and treatment plan were summarized with the literature. RESULTS: Both patients underwent total microscopic excision of the astrocytoma, and the correction rate of scoliosis was >50%. The pathological typing of both patients was WHO type II. Surgical resection of the tumor and repositioning were difficult. Both patients had partial recovery of sensory muscle strength of the extremities after surgery. Keywords: spinal cord astrocytoma; scoliosis; cobb angle, microsurgery Astrocytoma accounts for 30%-40% of intramedullary tumors in the spinal cord, and most of them have clinical symptoms of decreased sensation and muscle strength of the extremities under the plane of the spinal cord where the tumor is located, and less often combined with scoliosis. Case 1: A 15-year-old male was admitted to the hospital with scoliosis for more than 1 year and weakness of the left lower limb for 4 months. Examination: right-sided spinal curvature deformity, dorsal displacement of the right subscapularis angle, percussion pain at chest 5-12, no radiation. There was no banding sensation in the trunk. The knee joint of the left lower extremity was hypoesthesia, flexion and extension of the hip muscle strength grade IV, flexion and extension of the knee and flexion and extension of the toe muscle strength IV-. The muscle strength of the right lower limb was grade V. The muscle tone was normal, and the knee tendon reflex and Achilles tendon reflex were not elicited bilaterally. Bilateral baroreflex signs (+). The stereotaxic plain radiograph showed a right-sided curvature of the spine with a Cobb angle of 85°. Preoperative enhanced MRI: T5-T12 spinal cord with significant enhancement and heterogeneous high signal. Surgery: tumor resection by median approach behind the chest + scoliosis correction. The tumor was located in the medulla, grayish yellow, soft, rich in blood supply, poorly defined, and closely adhered to the spinal cord. Pathological diagnosis: astrocytoma with focal lamellar degenerative necrosis and scattered calcifications, WHO grade II. Preoperative standing plain film B: Preoperative 3D CT reconstruction C: Preoperative MRI sagittal (cervical segment) D: Preoperative MRI sagittal (thoracic segment) E: Postoperative X-ray F: Postoperative 3D CT reconstruction G: Postoperative MRI sagittal H: Postoperative MRI coronal Example 2: Male 14 years old was admitted to the hospital with scoliosis weakness of both lower limbs found for 6 years aggravated for 1 year. Examination: right-sided curvature deformity of the spine and right razorback deformity. The muscle strength of both upper limbs was grade V. No abnormal sensation was observed. The sensation and muscle tone of both lower limbs were normal, and the muscle strength of both lower limbs was grade IV. Bilateral patellar clonus and ankle clonus were positive. The knee tendon reflex and Achilles tendon reflex were hyperactive bilaterally. Bilateral baroreflex signs (+). Stereotaxic plain radiograph showed: right-sided curvature of the spine with a Cobb angle of 95°. Preoperative enhanced MRI: spinal cord thickening was seen in C7-T1 and thorax 9-12, with visible enhanced signal and scattered heterogeneous signal. The spinal cord cavity was visible inferiorly. Surgical approach: median approach tumor resection behind the thorax + scoliosis correction. After complete removal of the C7-T2 vertebral plate, the dura mater was seen to be bulging with high tension, and after suspension on both sides, the dura mater was cut medially and retracted on both sides, and the spinal cord was seen to be thickened microscopically with poor spinal cord pulsation, and the spinal cord was incised along the posterior median sulcus, and the tumor was seen to be located in the C7-T1 medulla, grayish yellow, soft in texture, with a medium blood supply, poorly defined borders, closely adherent to the spinal cord, surrounded by grayish yellow old hemorrhage, and with a cavity below. The scoliosis deformity was carefully separated from the adhesions and the size of the tumor was removed about 1.5*1*1 cm. after tumor removal. Thorough hemostasis was performed and the dura was tightly and continuously sutured. After biting off the posterior spinous process of thoracic 9-12 and part of the vertebral plate bilaterally, after suspension on both sides, the dura was cut open medially and retracted on both sides, and the spinal cord was seen to be thickened and poorly pulsating microscopically, and the spinal cord was incised along the posterior median sulcus. The adhesions were carefully separated and the tumor size was about 2.5*1.5*1.5 cm. Preoperative gross image B: Preoperative stereotaxic plain C: Preoperative 3D CT reconstruction D: Preoperative MRI sagittal E: Preoperative MRi coronal F: Preoperative MRI thoracic segment G: Postoperative gross image H: Postoperative 3D CT reconstruction I: Postoperative MRI sagittal RESULTS: Both patients underwent total microscopic excision for astrocytoma and scoliosis The correction rate was >50%, and the pathological staging was WHO type II in both patients. Surgical resection of the tumor and repositioning were difficult. Both patients had partial recovery of sensory muscle strength of the extremities after surgery. Scoliosis was significantly restored in both cases. The second patient had slightly high myotonicity, and muscle tone and muscle spasm improved after baclofen was given to release the spasm. Discussion: Astrocytoma is the most common neuroepithelial tumor. 3% of CNS astrocytomas grow in the spinal cord, and spinal cord astrocytomas account for 30% of all intramedullary tumors. They occur mostly before the age of 30 years, are mostly seen in women, and are prevalent in the cervical and thoracic segments of the spinal cord [1]. Histological types: hypofibrotic, hairy cell astrocytoma, ganglion glioblastoma, malignant astrocytoma, and glioblastoma. MRI: astrocytoma: equivocal or slightly low signal on T1WI, poorly defined and often eccentric lesions, low signal cysts often seen at the head and tail of the tumor, high signal on T2WI. The tumor is high signal on T2WI. After intensification, the tumor is seen as scattered patchy heterogeneous and mildly intensified. Early surgery after detection, intraoperative electrophysiological monitoring, and total microscopic excision based on preservation of neurological function as much as possible. The scoliosis research society (SRS) defines scoliosis as follows: a curvature of the spine with an angle greater than 10 degrees on a standing orthopantomogram measured by Cobb’s method is called scoliosis [2]. Scoliosis is divided into functional and structural types, and the latter is divided into idiopathic scoliosis of unknown origin and nonspecific scoliosis caused by various diseases such as congenital, metabolic, neurological and myogenic. Among them, idiopathic scoliosis is more common, accounting for about 80% of cases [3, 4]. In the present case, both patients were in adolescence, similar to the age of onset of idiopathic scoliosis, with scoliosis as the first symptom, followed by lower limb weakness, muscle atrophy, and foot valgus deformity. With the gradual growth of the tumor, spinal cord compression symptoms occur. According to the tumor growth segments, there are abnormal sensory planes corresponding to the segments and lower extremity muscle weakness and muscle tone abnormalities. The tumor will be examined by MRI and enhancement scan of the lesioned segment on standing X-ray and CT scan and 3D reconstruction of the scoliotic segment. The degree of scoliosis and the patient’s preoperative respiratory function were fully assessed. Early surgical resection is the key to treating spinal cord spinal tumors and ensuring the patient’s quality of life. In conclusion, the number of such patients is small, the follow-up period is short, and large clinical data are still needed to assess the prognosis of such patients. However, the available literature shows that early detection and surgery of these patients, along with microsurgical total resection of the tumor and correction of scoliosis or kyphosis using internal spinal fixation or vertebral reconstruction techniques, can effectively ensure the rate of total resection of spinal cord tumors and the outcome of surgical treatment. The simultaneous surgical correction of scoliosis at the same time as total resection of the tumor in the first stage of surgery is beneficial for patients to improve the quality and prolong the survival time.