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Optic pathway glioma in children: does visual deficit correlate with radiology in focal exophytic lesions?

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Abstract

Purpose

Unlike pilocytic astrocytomas in other parts of the brain, optic pathway gliomas (OPG) are usually diffuse lesions involving the anterior optic pathways and hypothalamus. Their infiltrative nature often precludes complete surgical resection. We sought to determine whether careful magnetic resonance (MR) analysis, correlated with visual deficits, could be sufficient to identify those focal lesions that may be amenable to more aggressive surgical resection at presentation.

Methods

We retrospectively reviewed the medical records of patients from two sites: children under 20 years of age treated for OPG between 1985 and 2009 at St Jude’s Children’s Research Hospital and children under 16 years of age treated at Great Ormond Street Hospital, London, UK, between 1984 and 2011. Patients with isolated optic nerve tumors were excluded. Visual acuity and visual field data at presentation were reviewed and correlated with MR characteristics, including extent of optic pathway involvement, symmetry, and lateral extension.

Results

Two hundred and one children were treated for OPG between 1984 and 2011 in the two institutions; 74 had neurofibromatosis 1 (NF1). At presentation, visual loss was symmetrical in 132 patients and asymmetrical in 69. Potential correlation between pattern of visual loss and tumor characteristics on routine MRI was found in only 13 patients with asymmetrical vision. There was no difference between patients with and without NF1.

Conclusion

The decision for aggressive surgical resection for optic pathway gliomas should be based on clinical criteria, particularly in children with good vision in one eye and poor vision in the other, as current MRI results do not reliably predict visual field deficits.

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Acknowledgments

The authors wish to thank Andrew J. Gienapp for copy editing and preparing the manuscript and figures for publishing.

Disclosure

No sources of support were received for this study. None of the authors have any financial conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Great Ormond Street Hospital, London, UK

    Kristian Aquilina & Kim Phipps

  2. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA

    David J. Daniels & Frederick A. Boop

  3. Division of Pediatric Neurosurgery, St Jude Children’s Research Hospital, Memphis, TN, USA

    David J. Daniels & Frederick A. Boop

  4. Developmental Endocrinology Research Group, Clinical & Molecular Genetics Unit, University College London Institute of Child Health, London, UK

    Helen Spoudeas & Hoong-Wei Gan

  5. Semmes Murphey Clinic, 6325 Humphreys Blvd., Memphis, TN, 38120, USA

    Frederick A. Boop

Authors
  1. Kristian Aquilina
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  2. David J. Daniels
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  3. Helen Spoudeas
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  4. Kim Phipps
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  6. Frederick A. Boop
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Correspondence to Frederick A. Boop.

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Aquilina, K., Daniels, D.J., Spoudeas, H. et al. Optic pathway glioma in children: does visual deficit correlate with radiology in focal exophytic lesions?. Childs Nerv Syst 31, 2041–2049 (2015). https://doi.org/10.1007/s00381-015-2855-7

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  • DOI: https://doi.org/10.1007/s00381-015-2855-7

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