Endoscopic transnasal resection of optic pathway pilocytic astrocytoma
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.
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.
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.
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.
KeywordsEndoscopic transnasal surgery Endoscopic endonasal approach Hypothalamic glioma Optic pathway glioma
We would like to thank the College of Medicine Research Center, Deanship of Scientific Research at King Saud University for supporting this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 8.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 70:110–124CrossRefGoogle Scholar
- 11.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
- 21.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):462–468CrossRefGoogle Scholar
- 26.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 B74:1–11Google Scholar
- 30.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):72–80Google Scholar
- 33.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 SurgGoogle Scholar