Abstract
Purpose
Optic pathway gliomas (OPGs) are low-grade neoplasms that primarily affect children. The management of OPGs remains controversial. Reports on the use of the endoscopic endonasal approach (EEA) in OPGs are extremely limited, and no such reports exist on its utility for pediatric OPGs. Here, we report our results and experience with OPGs treated with the EEA.
Methods
We retrospectively reviewed the medical records of OPG patients who were treated surgically via the EEA at our institutions from 2015 to 2017. Data on the demographics, clinical presentation, surgical complications, clinical outcomes, radiological imaging, and visual outcomes were recorded for each patient.
Results
Four cases were identified, with visual disturbances being the predominant complaint. The mean patient age was 15.5 years. Three cases showed normal preoperative hormonal profiles, but one patient had hypothyroidism. All tumors identified in this study were World Health Organization grade I pilocytic astrocytomas. Surgical complications included hypopituitarism in two patients, meningitis in two patients, cerebrospinal fluid leak in one patient, and transient diabetes insipidus in one patient. No patient experienced worsening neurological or visual symptoms postoperatively.
Conclusions
Although our data are preliminary, the EEA provides a direct corridor to OPG with acceptable results in terms of tumor resection and visual outcomes. Hypothalamic-pituitary axis dysfunction remains a limitation of any treatment modality for OPGs and should be considered whenever possible. Definitive conclusions are pending as the learning curve of this approach is steep. Further work is needed to understand patient selection for such an approach.
Similar content being viewed by others
References
El Beltagy MA, Reda M, Enayet A et al (2016) Treatment and outcome in 65 children with optic pathway gliomas. World Neurosurg 89:525–534
Dutton JJ (1994) Gliomas of the anterior visual pathway. Surv Ophthalmol 38:427–452
Binning MJ, Liu JK, Kestle JRW, Brockmeyer DL, Walker ML (2007) Optic pathway gliomas: a review. Neurosurg Focus 23:E2
Goodden J, Pizer B, Pettorini B et al (2014) The role of surgery in optic pathway/hypothalamic gliomas in children. J Neurosurg Pediatr 13:1–12
Zoli M, Mazzatenta D, Valluzzi A et al (2014) Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: preliminary report. Neurosurg Focus 37:E11
Somma T, Solari D, Beer-Furlan A et al (2017) Endoscopic endonasal management of rare sellar lesions: clinical and surgical experience of 78 cases and review of the literature. World Neurosurg 100:369–380
Abbassy M, Woodard TD, Sindwani R, Recinos PF (2016) An overview of anterior skull base meningiomas and the endoscopic endonasal approach. Otolaryngol Clin N Am 49:141–152
Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH (2011) Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery 70:110–124
Rajappa P, Margetis K, Sigounas D, Anand V, Schwartz TH, Greenfield JP (2013) Endoscopic endonasal transclival approach to a ventral pontine pediatric ependymoma: case report. J Neurosurg Pediatr 12:465–468
Sanborn MR, Kramarz MJ, Storm PB, Adappa ND, Palmer JN, Lee JY (2012) Endoscopic, endonasal, transclival resection of a pontine cavernoma: case report. Oper Neurosurg 71(suppl_1):onsE198–onsE203
Ajayi O, Chakravarthy V, Hanna G, DeLos Reyes K (2016) Surgical technique: endoscopic endonasal transphenoidal resection of a large suprasellar mixed germ cell tumor. Cureus 8(2):e503. https://doi.org/10.7759/cureus.503
Graffeo CS, Dietrich AR, Grobelny B et al (2014) A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors. Pituitary 17:349
Kasemsiri P, Carrau RL, Ditzel Filho LF et al (2014) Advantages and limitations of endoscopic endonasal approaches to the skull base. World Neurosurg 82:S12–S21
De Divitiis E, Cavallo LM, Cappabianca P, Esposito F (2007) Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 60:46–58
Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106(3):400–406
Thomas RP, Gibbs IC, Xu LW, Recht L (2015) Treatment options for optic pathway gliomas. Curr Treat Options Neurol l17:2
Fried I, Tabori U, Tihan T, Reginald A, Bouffet E (2013) Optic pathway gliomas: a review. CNS Oncol l2:143–159
Nicolin G, Parkin P, Mabbott D, Hargrave D, Bartels U, Tabori U, Bouffet E (2009) Natural history and outcome of optic pathway gliomas in children. Pediatr Blood Cancer 53(7):1231–1237
Jahraus CD, Tarbell NJ (2006) Optic pathway gliomas. Pediatr Blood Cancer 46:586–596
Massimi L, Tufo T, Di Rocco C (2007) Management of optic–hypothalamic gliomas in children: still a challenging problem. Expert Rev Anticancer Ther 7(11):1591–1610
Walker DA, Liu J, Kieran M, Jabado N, Picton S, Packer R, Van Damme A (2013) A multi-disciplinary consensus statement concerning surgical approaches to low-grade, high-grade astrocytomas and diffuse intrinsic pontine gliomas in childhood (CPN Paris 2011) using the Delphi method. Neuro-Oncology 15(4):462–468
Dehdashti AR, Ganna A, Karabatsou K, Gentili F (2008) Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006–1017
Paluzzi A, Fernandez-Miranda JC, Pinheiro-Neto C et al (2011) Endoscopic endonasal infrasellar approach to the sellar and suprasellar regions: technical note. Skull Base 21:335–342
Kassam A, Thomas AJ, Snyderman C et al (2007) Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg Pediatr 106:75–86
Arbolay OL, González JG, González RH, Gálvez YH (2009) Extended endoscopic endonasal approach to the skull base. Minim Invasive Neurosurg 52:114–118
Koutourousiou M, Gardner PA, Kofler JK, Fernandez-Miranda JC, Snyderman CH, Dade Lunsford L (2013) Rare infundibular tumors: clinical presentation, imaging findings, and the role of endoscopic endonasal surgery in their management. J Neurol Surg B74:1–11
Pollack IF (2014) Management of low-grade gliomas in childhood. World Neurosurg 81:265–267
Komotar RJ, Burger PC, Carson BS, Brem H, Olivi A, Goldthwaite PT, Tihan T (2004) Pilocytic and pilomyxoid hypothalamic/chiasmatic astrocytomas. Neurosurgery 54(1):72–80
Ahn Y, Cho BK, Kim SK, Chung YN, Lee CS, Kim IH, Wang KC (2006) Optic pathway glioma: outcome and prognostic factors in a surgical series. Childs Nerv Syst 22(9):1136–1142
Alalade AF, Ogando-Rivas E, Boatey J, Souweidane MM, Anand VK, Greenfield JP, Schwartz TH (2017) Suprasellar and recurrent pediatric craniopharyngiomas: expanding indications for the extended endoscopic transsphenoidal approach. J Neurosurg Pediatr 21(1):72–80
Stapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH, Wang EW (2017) Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol 93:163–166
Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC (2013) Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11(3):227–241
Giovannetti F, Mussa F, Priore P, Scagnet M, Arcovio E, Valentini V, Genitori L (2018) Endoscopic endonasal skull base surgery in pediatric patients. A single center experience. J Cranio-Maxillofac Surg
Bridges KJ, Li R, Fleseriu M, Cetas JS (2017) Candida meningitis after transsphenoidal surgery: a single-institution case series and literature review. World Neurosurg 108:41–49
Miller C, Guillaume D, Dusenbery K, Clark HB, Moertel C (2017) Report of effective trametinib therapy in 2 children with progressive hypothalamic optic pathway pilocytic astrocytoma: documentation of volumetric response. J Neurosurg Pediatr 19(3):319–324
Acknowledgments
We would like to thank the College of Medicine Research Center, Deanship of Scientific Research at King Saud University for supporting this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Bin Abdulqader, S., Al-Ajlan, Z., Albakr, A. et al. Endoscopic transnasal resection of optic pathway pilocytic astrocytoma. Childs Nerv Syst 35, 73–81 (2019). https://doi.org/10.1007/s00381-018-3994-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-018-3994-4