Surgical Management of Optic Pathway-Hypothalamic Gliomas: Institutional Experience and Systematic Review

Because of the proximity of optic pathway-hypothalamic gliomas (OPHGs) to critical neuroanatomical structures and their unpredictable natural history, the role of resection in their treatment is often debated. We present our institutional surgical experience and a systematic review of outcomes in patients with surgically treated OPHG.

The health records of patients with OPHGs who underwent surgery at our institution were retrospectively reviewed. A systematic review of the literature was also performed to extract surgically treated OPHG cases. Clinical presentation, surgical approach, extent of resection, complications, and outcomes were analyzed.

A total of 9 adult patients from our institution were included (mean age 32.3 ± 17.3 years; 5 women [56%]), and we identified 15 studies that met inclusion criteria with a total of 50 patients (mean age 14.4 ± 11.2 years; 24 women [48%]). Visual disturbance was the most common presenting symptom (56% of our patients and 76% of patients from the literature). The most common pathology was pilocytic astrocytoma (67% in our cohort, 62% of patients in the literature). In our cohort, tumors involved the hypothalamus (67%), optic chiasm (67%), and optic nerve (56%), and 33% of patients had gross total resection. In the historical cases, tumors involved the hypothalamus (94%), optic chiasm (42%), and optic nerve (16%), and 12% of patients had gross total resection. Complications in our series included diabetes insipidus (11%), anterior choroidal infarct (11%), and ptosis (11%), and in the literature, new endocrine dysfunction (28%) and visual disturbance (16%) were reported. Three patients (33%) had tumor recurrence at a mean of 27.3 ± 7.6 months, whereas 11 patients (22%) reported in the literature had tumor recurrence at a mean of 55.7 ± 44.3 months.

Surgery can be performed with reasonable risk and can play a key role in the multidisciplinary management of select patients with OPHG.