Management of pregeniculate anterior visual pathway gliomas

Gliomas of the pregeniculate anterior visual pathways comprise about 5% of all intracranial tumors that occur in the first decade of life. Gliomas are the most common primary optic nerve tumor. Diagnosing a glioma of the anterior visual pathways is much easier since the advent of computerized tomography (CT) and magnetic resonance imaging (MRI); the continuing problem is appropriate management. Improved guidelines for management are suggested based on a review of the literature and the authors' experience. These guidelines include both the need to characterize accurately the location of the tumor and its clinical and radiologic progression, and the imperative to employ active intervention only when there is a specific therapeutic goal that can be used for measuring the success of the treatment.