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Management of Optic Chiasmatic/ Hypothalamic Astrocytomas in Children

Published online by Cambridge University Press:  14 September 2018

Paul Steinbok ,
Stephen Hentschel ,
Per Almqvist ,
D. Douglas Cochrane  and
Kenneth Poskitt
Paul Steinbok*
Affiliation:
Division of Pediatric Neurosurgery, Department of Radiology, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada
Stephen Hentschel
Affiliation:
Division of Pediatric Neurosurgery, Department of Radiology, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada
Per Almqvist
Affiliation:
Division of Pediatric Neurosurgery, Department of Radiology, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada
D. Douglas Cochrane
Affiliation:
Division of Pediatric Neurosurgery, Department of Radiology, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada
Kenneth Poskitt
Affiliation:
Department of Surgery, and Division of Neuroradiology, Department of Radiology, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada
*
Paul Steinbok, Division of Neurosurgery, British Columbia’s Children’s Hospital, 4480 Oak Street, #A325, Vancouver, BC, V6H 3V4
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Abstract:

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Objective:

The management of optic chiasmatic gliomas is controversial, partly related to failure to separate out those tumors involving the optic chiasm only (chiasmatic tumors) from those also involving the hypothalamus (chiasmatic/hypothalamic tumors). The purpose of this study was: (i) to analyze the outcomes of chiasmatic and chiasmatic/hypothalamic tumors separately; and (ii) to determine the appropriateness of recommending radical surgical resection for the chiasmatic/hypothalamic tumors.

Methods:

A retrospective chart review of all newly diagnosed tumors involving the optic chiasm from 1982-1996 at British Columbia’s Children’s Hospital was performed.

Results:

There were 32 patients less than 16 years of age, 14 with chiasmatic and 18 with chiasmatic/hypothalamic astrocytomas, with an average duration of follow-up of 5.8 years and 6.3 years, respectively. Ten of the patients with chiasmatic tumors and none with chiasmatic/hypothalamic tumors had neurofibromatosis I. Thirteen of the 14 chiasmatic tumors were managed with observation only, and none had progression requiring active intervention. For the chiasmatic/hypothalamic tumors, eight patients had subtotal resections (>95% resection), six had partial resections (50-95%), three had limited resections (<50%), and one had no surgery. There were fewer complications associated with the limited resections, especially with respect to hypothalamic dysfunction. There was no correlation between the extent of resection (subtotal, partial, or limited) and the time to tumor progression (average 18 months).

Conclusions:

In conclusion, chiasmatic and chiasmatic/hypothalamic tumors are different entities, which should be separated out for the purposes of any study. For the chiasmatic/hypothalamic tumors, there was more morbidity and no prolongation of time to progression when radical resections were compared to more limited resections. Therefore, if surgery is performed, it may be appropriate to do a surgical procedure that strives only to provide a tissue diagnosis and to decompress the optic apparatus and/or ventricular system.

Résumé:

Résumé:Objectif:

La prise en charge des gliomes du chiasma optique est controversée, en partie parce qu’on ne fait pas de distinction entre les tumeurs impliquant seulement le chiasma optique (tumeurs chiasmatiques) et celles qui impliquent également l’hypothalamus (tumeurs chiasmatiques/hypothalamiques). Les objectifs de cette étude étaient: (i) d’analyser séparément l’issue des tumeurs chiasmatiques et chiasmatiques/hypothalamiques; et (ii) de déterminer la pertinence de recommander la résection chirurgicale radicale des tumeurs chiasmatiques/hypothalamiques.

Méthode:

Nous avons procédé à une revue rétrospective des dossiers de patients porteurs de tumeurs nouvellement diagnostiquées impliquant le chiasma optique entre 1982 et 1996 au Children’s Hospital de la Colombie Britannique.

Résultats:

L’étude porte sur 32 patients de moins de 16 ans, 14 présentant un astrocytome chiasmatique et 18 un astrocytome chiasmatique/hypothalamique. La durée moyenne du suivi était de 5,8 ans et 6,3 ans respectivement. Dix des patients porteurs de tumeurs chiasmatiques étaient atteints de neurofibromatose de type I alors qu’aucun des patients porteurs de tumeurs chiasmatiques/hypothalamiques n’en étaient atteints. La conduite pour 13 des 14 tumeurs chiasmatiques a été l’observation seulement et aucune n’a nécessité une intervention à cause de la progression de la tumeur. Quant aux patients atteints de tumeurs chiasmatiques/hypothalamiques, huit ont subi une résection subtotale (résection de plus de 95%), six ont subi une résection partielle (de 50 à 95%), trois ont subi une résection limitée (de moins de 50%) et un n’a pas été opéré. Il y a eu moins de complications associées aux résections limitées, surtout quant à la dysfonction hypothalamique. Il n’existait pas de corrélation entre l’étendue de la résection (subtotale, partielle ou limitée) et le moment de la récidive (en moyenne 18 mois).

Conclusions:

Les tumeurs chiasmatiques et chiasmatiques/hypothalamiques sont des entités différentes qui devraient être considérées séparément dans les études. Pour les tumeurs chiasmatiques/hypothalamiques, il y avait davantage de morbidité, sans prolongation du temps de rémission, quand on compare la résection radicale à la résection limitée. Si on a recours à la chirurgie, il peut être approprié de faire une intervention dont le but n’est que de fournir un diagnostic anatomopathologique et de décomprimer l’appareil optique et/ou le système ventriculaire.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 2 , May 2002 , pp. 132 - 138
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Oxenhandler, D, Sayers, M. The dilemma of childhood optic gliomas. J Neurosurg 1978;48:34-41.CrossRefGoogle Scholar
2. Hoyt, W, Baghdassarian, S. Optic glioma of childhood. Natural history and rationale for conservative management. Br J Ophthalmol 1969;53:796-798.CrossRefGoogle Scholar
3. Rush, J, Younge, B, Campbell, R, MacCarty, C. Optic glioma: longterm follow-up of 85 histopathologically verified cases. Ophthalmology 1982;89:1213-1219.CrossRefGoogle Scholar
4. Flickinger, J, Torres, C, Deutsch, M. Management of low-grade gliomas of the optic nerve and chiasm. Cancer 1988;61:635-642.3.0.CO;2-2>CrossRefGoogle Scholar
5. Tenny, R, Jr. Laws, ER, Younge, B, Rush, J. The neurosurgical management of optic glioma. J Neurosurg 1982;57:452-458.CrossRefGoogle Scholar
6. Pierce, S, Barnes, P, Loeffler, J. Definitive radiation therapy in the management of symptomatic patients with optic glioma. Cancer 1990;65:45-52.3.0.CO;2-Z>CrossRefGoogle Scholar
7. Horwich, A, Bloom, H. Optic gliomas: radiation therapy and prognosis. Int J Radiat Oncol Biol Phys 1985;11:1067-1079.CrossRefGoogle Scholar
8. Kovalic, J, Grigsby, P, Shepard, M, et al. Radiation therapy for gliomas of the optic nerve and chiasm. Int J Radiat Oncol Biol Phys 1990;18:927-932.CrossRefGoogle Scholar
9. Rodriguez, L, Edwards, M, Levin, V. Management of hypothalamic gliomas in children: an analysis of 33 cases. Neurosurgery 1990;26:242-247.CrossRefGoogle Scholar
10. Montgomery, A, Griffin, T, Parker, R, Gerdes, A. Optic nerve glioma: the role of radiation therapy. Cancer 1977;40:2079-2080.3.0.CO;2-4>CrossRefGoogle Scholar
11. Danoff, B, Kramer, S, Thompson, N. The radiotherapeutic management of optic nerve gliomas in children. Int J Radiat Oncol Biol Phys 1980;6:45-50.CrossRefGoogle Scholar
12. Servo, A, Puranen, M. Moyamoya syndrome as a complication of radiation therapy. J Neurosurg 1978;48:1026-1029.CrossRefGoogle Scholar
13. Okuno, T, Prensky, A, Grado, M. The moyamoya syndrome associated with irradiation of an optic glioma in children. Report of two cases and review of the literature. Pediatr Neurol 1985;1:311-316.CrossRefGoogle Scholar
14. Beyer, R, Paden, P, Sobel, D, Flynn, F. Moyamoya pattern of vascular occlusion after radiotherapy for glioma of the optic chiasm. Neurology 1986;36:1173-1178.CrossRefGoogle Scholar
15. Kestle, J, Hoffman, H, Mock, A. Moyamoya phenomenon after radiation for optic glioma. J Neurosurg 1993;79:32-35.CrossRefGoogle Scholar
16. Rappaport, R, Brauner, R. Growth and endocrine disorders secondary to cranial irradiation. Pediatr Res 1989;25:561-567.CrossRefGoogle Scholar
17. Hoffman, H, Humphreys, R, Drake, J, et al. Optic pathway/ hypothalamic gliomas: a dilemma in management. Pediatr Neurosurg 1993;19:186-195.CrossRefGoogle Scholar
18. Aquino, V, Fort, D, Kamen, B. Carboplatin for the treatment of children with newly diagnosed optic chiasm gliomas: a phase II study. J Neurooncol 1999;41:255-259.CrossRefGoogle Scholar
19. Petronio, J, Edwards, M, Prados, M, et al. Management of chiasmal and hypothalamic gliomas of infancy and childhood with chemotherapy. J Neurosurg 1991;74:701-708.CrossRefGoogle Scholar
20. Rosenstock, J, Packer, R, Bilaniuk, L, et al. Chiasmatic optic glioma treated with chemotherapy. A preliminary report. J Neurosurg 1985;63:862-866.CrossRefGoogle Scholar
21. Jenkin, D, Angyalfi, S, Becker, L, et al. Optic glioma in children: surveillance, resection, or irradiation? Int J Radiat Oncol Biol Phys 1993;25:215-225.CrossRefGoogle Scholar
22. Wisoff, J, Abbott, R, Epstein, F. Surgical management of exophytic chiasmatic-hypothalamic tumors of childhood. J Neurosurg 1990;73:661-667.CrossRefGoogle Scholar
23. Hoffman, H, Soloniuk, D, Humphreys, R, et al. Management and outcome of low-grade astrocytomas of the midline in children: a retrospective review. Neurosurgery 1993;33:964-971.Google Scholar
24. Sutton, L, Molloy, P, Sernyak, H. Long-term outcome of hypothalamic/chiasmatic astrocytomas in children treated with conservative surgery. J Neurosurg 1995;83:583-589.CrossRefGoogle Scholar
25. Medlock, MD, Scott, RM. Optic chiasm astrocytomas of childhood. 2. Surgical management. Pediatr Neurosurg 1997;27:121-128.CrossRefGoogle Scholar
26. Daaboul, J, Steinbok, P. Abnormalities of water metabolism after surgery for optic/chiasmatic astrocytomas in children. Pediatr Neurosurg 1998;28:181-185.CrossRefGoogle Scholar
27. Lim, Y, Leem, W. Two cases of gamma knife radiosurgery for lowgrade optic chiasm glioma. Stereotact Funct Neurosurg 1996;66:174-183.CrossRefGoogle Scholar
28. Debus, J, Kocagoncu, K, Hoss, A, et al. Fractionated stereotactic radiotherapy (FSR) for optic glioma. Int J Radiat Oncol Biol Phys 1999;44:243-248.CrossRefGoogle Scholar
29. Packer, R, Sutton, L, Bilaniuk, L, et al. Treatment of chiasmatic/hypothalamic gliomas of childhood with chemotherapy: an update. Ann Neurol 1988;23:79-85.CrossRefGoogle Scholar
30. Allen, J. Initial management of children with hypothalamic and thalamic tumors and the modifying role of neurofibromatosis-1. Pediatr Neurosurg 2000;32:154-162.CrossRefGoogle Scholar
31. Silva, M, Goldman, S, Keating, G, et al. Optic pathway hypothalamic gliomas in children under three years of age: the role of chemotherapy. Pediatr Neurosurg 2000;33:151-158.CrossRefGoogle Scholar