Pilocytic astrocytoma (PA) is a rare, low-grade glioma predominantly affecting children and young adults, with a favorable prognosis and a high survival rate. Despite its' slow growth, PA often presents with significant symptoms at diagnosis due to its tendency to reach a large size, especially in pediatric patients, where compensatory mechanisms can delay detection. This case report describes a 7-year-old girl with progressive vision loss, headache, and balance disturbance. The imaging result revealed a right cerebellar mass that was in accordance with pilocytic astrocytoma and obstructive hydrocephalus. Histopathologic analysis confirmed the diagnosis with the typical features of PA such as Rosenthal fibers and eosinophilic granular bodies. This case report highlights the critical role of radiologic and histopathologic evaluations for PA diagnosis and management
also the unique presentation and challenges in managing PA, emphasizing the importance of timely intervention to optimize neurological outcomes.