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Endoscopic transnasal surgery in optic pathway gliomas located in the chiasma-hypothalamic region: case series of ten patients in a single-center experience and endoscopic literature review

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Abstract

Objective

Optic pathway gliomas (OPGs) constitute approximately 3–5% of childhood intracranial tumors. In this study, the authors presented their experience of using the endoscopic endonasal approach to treat patients with OPG located in the chiasma-hypothalamic region and aimed to use the infrachiasmatic corridor in the endoscopic endonasal approach as an alternative to the transcranial approach in the surgical necessity of OPGs.

Methods

We retrospectively analyzed the data of ten patients diagnosed with OPG histopathologically among 3757 cases who underwent endoscopic endonasal surgery between August 1997 and March 2021 at Kocaeli University Faculty of Medicine Pituitary Research Center and Department of Neurosurgery. Mean follow-up period 48.5 months. During the postoperative follow-up period, 3 of these 10 patients underwent reoperation due to tumor recurrence. Combined (endoscopic endonasal approach + transcranial approach) approach was applied to 2 patients in the same session. Surgical and clinical outcomes were evaluated in detail.

Results

Ten patients with a mean patient age of 20.6 ± 11.4 were included in this study. The most common complaint was visual impairment. After surgery, improvement in visual impairment was observed in five patients. No increase in postoperative visual impairment was observed in any of the patients. Postoperative panhypopituitarism was not observed in any of the patients. STR resection was performed in 5 patients and NTR resection in 5 patients. No additional treatment was required during follow-up in 4 of 5 patients who underwent NTR. A total of 6 patients received postoperative radiotherapy treatment.

Conclusions

In gliomas located in the chiasma-hypothalamic region, appropriate patient selection and endoscopic endonasal surgical treatment may contribute to the elimination of symptoms due to the mass effect of the tumor. It may also contribute to keeping the disease under control with targeted adjuvant therapies by clarifying the pathological diagnosis of the lesion.

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Availability of data and material

The data and materials of the patients used in the study are in the archive of our hospital.

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Authors and Affiliations

  1. Pituitary Research Center, Neurosurgery Department, Kocaeli University, Kocaeli, Kocaeli, Turkey

    Eren Yilmaz, Ecem Cemre Ceylan, Burak Cabuk, Ihsan Anik & Savas Ceylan

  2. Neurosurgery Department, Kocaeli State Hospital, Kocaeli, Kocaeli, Turkey

    Atakan Emengen

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  1. Eren Yilmaz
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Contributions

The idea for the article came up by Savas Ceylan. Savas Ceylan, Eren Yilmaz, and Ecem Cemre Ceylan carried out the literature review and data analysis. Eren Yilmaz, Atakan Emengen, Burak Cabuk, Ihsan Anik, and Savas Ceylan wrote the main manuscript text and Ecem Cemre Ceylan prepared Figs. 2, 3, 4, and 5. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Savas Ceylan.

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Ethics approval and consent to participate

The study has the approval of the ethics committee. Consent was obtained from the adult patients included in the study and the parents of patients younger than 18 years old.

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Consent was obtained from the patients included in the study to publish their data in a journal article. This consent was obtained from the adult patients themselves and from the parents of the patients younger than 18 years old.

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The authors declare no competing interests.

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Yilmaz, E., Emengen, A., Ceylan, E.C. et al. Endoscopic transnasal surgery in optic pathway gliomas located in the chiasma-hypothalamic region: case series of ten patients in a single-center experience and endoscopic literature review. Childs Nerv Syst 38, 2071–2082 (2022). https://doi.org/10.1007/s00381-022-05665-7

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