Summary
The authors review the therapeutic results of 20 patients (aged 12 months to 30 years, mean age 9 years) with benign pilocytic astrocytoma of the chiasmatic/hypothalamic region, seen at the University Hospital Hamburg-Eppendorf between February 1980 and April 1993. Six patients suffered from neurofibromatosis 1 (NF-1). The patients were divided into two subgroups relative to tumour extension and growth patterns, as revealed by CT scans and/or MR imaging. Fourteen patients revealed a large globular suprasellar tumour extending into the hypothalamus and/or the anterior third ventricle (group A). A suprasellar tumour with optic tract involvement could be identified in six cases (group B). Subtotal (70–90%) resection was achieved in ten tumours (50%), the majority of which were of the large globular type. There were no deaths. Postoperative morbidity was comprised of visual and endocrine impairment in four patients and right hemiparesis and dysphasia in one patient. Radiation therapy was given in nine cases (45%). Three tumours (38%) were reduced in size by irradiation. Tumour progression was seen in seven patients (35%). The presence of young age and NF-1 were predictors of progressive disease in our series. Growth capacity was not related to the extent of cytoreductive surgery.
Similar content being viewed by others
References
Albright AL, Sclabassi RJ (1985) Cavitron ultrasonic surgical aspirator and visual evoked potential monitoring for chiasmal gliomas in children. Report of two cases. J Neurosurg 63: 138–140
Alvord EC, Lofton S (1988) Gliomas of the optic nerve and chiasm. Outcome by patients' age, tumour site, and treatment. J Neurosurg 68: 85–98
Brauner R, Malandry F, Rappaport R, Zucker JM, Kalifa C, Pierre-Kahn A (1990) Growth and endocrine disorders in optic glioma. Eur J Pediatr 149: 825–828
Brown EW, Riccardi VM, Mawad M, Handel S, Goldman A, Bryan RN (1987) MR imaging of optic pathways in patients with neurofibromatosis. AJNR 8: 1031–1036
Brzowski AE, Bazan III C, Mumma JV, Ryan SG (1992) Spontaneous regression of optic glioma in a patient with neurofibromatosis. Neurology 42: 679–681
Dosoretz DE, Blitzer PH, Wang CC, Linggood RM (1980) Management of glioma of the optic nerve and/or chiasm. Cancer 45: 1467–1471
Duffner PK, Cohen ME, Thompson PRM (1985) The long-term effects of cranial irradiation on the central nervous system. Cancer 56: 1841–1847
Fletcher WA, Imes RK, Hoyt WF (1986) Chiasmal gliomas: appearance and long-term changes demonstrated by computerized tomography. J Neurosurg 65: 154–159
Flickinger JC, Torres C, Deutsch M (1988) Management of low-grade gliomas of the optic nerve and chiasm. Cancer 61: 635–642
Gillet GR, Symon L (1987) Hypothalamic glioma. Surg Neurol 28: 291–300
Heiksanen O, Raitta C, Torsti R (1978) The management and prognosis of gliomas of the optic pathways in children. Acta Neurochir (Wien) 43: 193–199
Horwich A, Bloom HJG (1985) Optic gliomas: radiation therapy and prognosis. Int J Radiat Oncol Biol Phys 11: 1067–1079
Hoyt WF, Baghdassarian SA (1969) Optic glioma of childhood: natural history and rational for conservative management. Br J Ophthalmol 53: 793–798
Imes RK, Hoyt WF (1986) Childhood chiasmal gliomas: update on the fate of patients in the 1969 San Francisco study. Br J Ophthalmol 70: 179–182
Kanamori M, Shibuya M, Yoshida J, Takayasu M, Kageyama N (1985) Long-term follow-up of patients with optic glioma. Childs Nerv Syst 1: 272–278
Kovalic JJ, Grigsby PW, Shepard MJ, Fineberg BB, Thomas PR (1990) Radiation therapy for gliomas of the optic nerve and chiasm. Int J Radiat Oncol Biol Phys 18: 927–932
Lee YY, Van Tassel P, Bruner JM, Moser RP, Share JC (1989) Juvenile pilocytic astrocytomas: CT and MR characteristics. AJNR 152: 1263–1270
Listernick R, Charrow J, Greenwald M (1992) Emergence of optic pathway gliomas in children with neurofibromatosis type 1 after normal neuroimaging results. J Pediatr 121: 584–587
Mohadjer M, Etou A, Milios E, Baden R, Mundinger F (1991) Chiasmatic optic glioma. Neurochirurgia (Stuttg) 34: 90–93
Packer RJ, Savino PJ, Bilaniuk LT, Zimmermann RA, Schatz NJ, Rosenstock JG, Nelson DS, Jarret PD, Bruce DA, Schut L (1983) Chiasmatic gliomas of childhood. A reappraisal of natural history and effectiveness of cranial irradiation. Childs Brain 10: 393–403
Packer RJ, Sutton LN, Bilaniuk LT, Radcliffe J, Rosenstock JG, Siegel KR, Bunin GR, Savino PJ, Bruce DA, Schut L (1988) Treatment if chiasmatic/hypothalamic gliomas in childhood with chemotherapy: an update. Ann Neurol 23: 79–85
Petronio J, Edwards MSB, Prados M, Freyberger S, Rabbitt J, Silver P, Levin VA (1991) Management of chiasmal and hypothalamic gliomas of infancy and childhood with chemotherapy. J Neurosurg 74: 701–708
Pierce SM, Barnes PD, Loeffler JS, McGinn C, Tarbell NJ (1990) Definitive radiation therapy in the management of symptomatic patients with optic glioma. Cancer 65: 45–52
Rodriguez LA, Edwards MSB, Levin VA (1990) Management of hypothalamic gliomas in children: an analysis of 33 cases. Neurosurgery 26: 242–247
Rush JA, Younge BR, Campbell RJ, MacCarty CS (1982) Optic glioma: long-term follow-up of 85 histopathologically verified cases. Opthalmology 89: 1213–1219
Stern J, DiGiacinto CV, Housepian EM (1979) Neurofibromatosis and optic glioma: clinical and morphological correlations. Neurosurgery 4: 524–528
Tenny RT, Laws ER, Younge BR, Rush JA (1982) The neurosurgical management of optic glioma: results in 104 patients. J Neurosurg 57: 452–458
Weiss L, Sagerman RH, King GA, Chung CT, Dubowy RL (1987) Controversy in the management of optic nerve glioma. Cancer 59: 1000–1004
Wisoff JH, Abbott R, Epstein F (1990) Surgical management of exophytic chiasmatic/hypothalamic tumours of childhood. J Neurosurg 73: 661–667
Wong JYC, Uhl V, Wara WM, Sheline GE. Optic gliomas (1987) A reanalysis of the university of California, San Francisco experience. Cancer 60: 1847–1855
Author information
Authors and Affiliations
Additional information
Dedicated to Prof. Dr. H.-D. Herrmann on the occasion of his 60th birthday.
Rights and permissions
About this article
Cite this article
Valdueza, J.M., Lohmann, F., Dammann, O. et al. Analysis of 20 primarily surgically treated chiasmatic/hypothalamic pilocytic astrocytomas. Acta neurochir 126, 44–50 (1994). https://doi.org/10.1007/BF01476493
Issue Date:
DOI: https://doi.org/10.1007/BF01476493