ObjectiveTo explore the clinical features, diagnosis, treatment, and prognosis of spinal pilocytic astrocytoma.MethodsFrom January 2011 to December 2017, a total of 12 cases of spinal pilocytic astrocytoma were enrolled in Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to the Capital Medical University and Peking University International Hospital. They all received microscopic surgery and the pathologic diagnosis were spinal cord pilocytic astrocytoma; the clinical and radiographic features, treatment and prognosis were retrospectively analyzed.ResultsThere were 9 males and 3 females in this group, with an average age of 25.5 years. Clinical manifestations were related to tumor occupying effect. All the tumors were intramedullary tumors, in which 5 cases located in the cervical spinal cord, and 7 in the thoracic segments. Preoperative medical history recording, physical examination and imaging examination misdiagnosed the tumor as spinal cord ependymoma in 10 cases, enterogenous cyst in 1 case, and high-grade glioma in 1 case. All patients were treated with microsurgical excision: 8 were resected totally, 3 were subtotally, and 1 was partially. None of the patients died after surgery, and the mean follow-up time was 43.1 months. The symptoms of 9 patients were significantly improved, 2 showed no significant change, and 1 had worse symptoms after surgery. No reoperation occured. Two patients underwent routine radiotherapy, and no chemotherapy was performed.ConclusionsSpinal pilocytic astrocytoma tends to occur in adolescent patients with cervical and thoracic spinal cord as the predilection site; the diagnosis is mainly on the basis of tumor tissue typical two-way structure, Rosenthal fiber, and eosinophilic granular corpuscle. Preoperative medical history, physical examination and imaging examination are easily misdiagnosed as spinal cord ependymoma. Prognosis of surgical treatment is very good.