gms | German Medical Science

Objective: To evaluate the indication for surgery and the extent of resection in low-grade gliomas arising from the optic pathway in pediatric patients

Methods: The study presents a retrospective series of 20 children (13 boys, 7 girls; mean age 8years) with tumors of the optic pathway. In those patients (10) with the tumor restricted to the optic nerve, complete tumor removal was achieved via a cranioorbital approach. A biopsy or gross tumor reduction via a pterional or subfrontal approach was performed in children (10), in whom the optic chiasm was involved. Histological examination diagnosed pilocytic astrocytoma in all cases. All children were closely followed by clinical examination and MRI scans.

Results: Leading symptoms were deterioration of vision and proptosis. Mean follow-up was 25 months. In the group of 10 children with optic nerve gliomas none showed evidence of tumor recurrence at last follow-up. Of those children with invasion of the optic chiasm, in whom a biopsy or reduction was done, 4 had a progressive disease and were thereupon admitted to chemo- or radiotherapy. 1 boy died consecutively due to incurable tumor progress. In the remaining 9 children a stable tumor was presented at last follow-up. Operative morbidity consisted of hemiparesis in 2 children, cranial nerve dysfunction and liquorrhoe. The proptosis was corrected to an at least satisfying esthetic degree.

Conclusions: The study clearly shows that low-grade gliomas of the optic pathway, although a unique histological entity, have to be divided into two groups: those, only affecting the optic nerve, in which radical tumor resection has to be the aim of surgery, as it grants tumor free survival. And those invading the optic chiasm and optic tract, that are hardly ever suitable for gross resection, due to high operative morbidity. Because of the tumor remaining, a close follow-up with clinical examination and MRI scans has to be done.