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[Infantile optic glioma involving the whole optic pathway--a case report]
Insights
This case study details an infantile optic glioma affecting the entire optic pathway in a 4-month-old. Treatment involved surgery, a VP shunt, and radiation, leading to tumor reduction and a positive outcome.
Area of Science:
- Neuro-oncology
- Pediatric ophthalmology
- Neuroradiology
Background:
- Optic pathway gliomas are rare pediatric brain tumors.
- Infantile optic gliomas can present with varied clinical manifestations.
- Early diagnosis and comprehensive management are crucial for outcomes.
Observation:
- A 4-month-old female presented with lethargy and visual impairment.
- Ophthalmological examination revealed delayed pupillary light reaction and choked discs.
- Imaging demonstrated a diffuse optic pathway glioma involving the entire visual pathway.
Findings:
- Histopathological diagnosis confirmed optic glioma.
- Initial surgical debulking was followed by a ventriculoperitoneal (VP) shunt for hydrocephalus.
- Radiation therapy led to significant tumor shrinkage and stabilization.
Implications:
- This case highlights the importance of prompt diagnosis and multimodal treatment for extensive infantile optic gliomas.
- Aggressive management, including surgery, shunting, and radiation, can achieve favorable outcomes.
- Long-term surveillance is essential for monitoring residual disease and potential complications.
Abstract:
A case of infantile optic glioma involving the whole optic pathway is reported. The patient was a 4-month-old female. The mother noticed that the baby could not follow the object, although her physical development had been apparently normal only until three months after birth. On admission, she was lethargic, although no definite motor weakness was identified. The ophthalmological check revealed delayed bilateral pupillary light reaction and choked disks. Skull X-ray film showed the J-shaped sella and the enlarged bilateral optic canals. CT scan also revealed an isodensity mass in the suprasellar cistern and enlarged bilateral optic nerves. The lesions were enhanced homogeneously with contrast medium and extended toward both optic radiations. Lateral ventricles were mildly dilated. Cerebral angiography showed the upward shift of A1-portion of the bilateral anterior cerebral arteries and the backward shift of the basilar artery. No abnormal vessels were visible. A bifrontal craniotomy was performed to partially remove the suprasellar tumor. The histological diagnosis was optic glioma. The postoperative course was uneventful. The patient was discharged without any neurological deficits except poor visual acuity. Four months later, she suddenly fell into generalized convulsion. CT scan revealed the significant enlargement of residual tumor and ventricular dilatation. Surgical treatment of VP shunt was immediately performed on, and then irradiation of 4,000 rad of total dose to the tumor followed. The tumor size became definitively small. On a follow-up term of 15 months, the patient has been doing well.(ABSTRACT TRUNCATED AT 250 WORDS)