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Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm

Optic pathway gliomas in children carry significant morbidity and therapeutic challenges. For the subgroup of pre-chiasmatic gliomas, intraorbital and intradural resection is a curative option after blindness. We present a two-center cohort using different surgical approaches. A retrospective analys...

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Autores principales: Zipfel, Julian, Tellermann, Jonas, Besch, Dorothea, Bertelmann, Eckart, Ebinger, Martin, Driever, Pablo Hernáiz, Schittenhelm, Jens, Beschorner, Rudi, Koch, Arend, Thomale, Ulrich-Wilhelm, Schuhmann, Martin Ulrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9029433/
https://www.ncbi.nlm.nih.gov/pubmed/35455503
http://dx.doi.org/10.3390/children9040459
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author Zipfel, Julian
Tellermann, Jonas
Besch, Dorothea
Bertelmann, Eckart
Ebinger, Martin
Driever, Pablo Hernáiz
Schittenhelm, Jens
Beschorner, Rudi
Koch, Arend
Thomale, Ulrich-Wilhelm
Schuhmann, Martin Ulrich
author_facet Zipfel, Julian
Tellermann, Jonas
Besch, Dorothea
Bertelmann, Eckart
Ebinger, Martin
Driever, Pablo Hernáiz
Schittenhelm, Jens
Beschorner, Rudi
Koch, Arend
Thomale, Ulrich-Wilhelm
Schuhmann, Martin Ulrich
author_sort Zipfel, Julian
collection PubMed
description Optic pathway gliomas in children carry significant morbidity and therapeutic challenges. For the subgroup of pre-chiasmatic gliomas, intraorbital and intradural resection is a curative option after blindness. We present a two-center cohort using different surgical approaches. A retrospective analysis was performed, including 10 children. Mean age at surgery was 6.8 years. Interval between diagnosis and surgery was 1–74 (mean 24 ± 5.5, median 10) months. Indications for surgery were exophthalmos, pain, tumor progression, or a combination. Eight patients underwent an extradural trans-orbital-roof approach to resect the intra-orbital tumor, including the optic canal part plus intradural pre-chiasmatic resection. Gross total resection was achieved in 7/8, and none had a recurrence. One residual behind the bulbus showed progression, treated by chemotherapy. In two patients, a combined supra-orbital mini-craniotomy plus orbital frame osteotomy was used for intraorbital tumor resection + intradural pre-chiasmatic dissection. In these two patients, remnants of the optic nerve within the optic canal remained stable. No patient had a chiasmatic functional affection nor permanent oculomotor deficits. In selected patients, a surgical resection from bulb to chiasm ± removal of optic canal tumor was safe without long-term sequela and with an excellent cosmetic result. Surgery normalizes exophthalmos and provides an effective tumor control.
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spelling pubmed-90294332022-04-23 Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm Zipfel, Julian Tellermann, Jonas Besch, Dorothea Bertelmann, Eckart Ebinger, Martin Driever, Pablo Hernáiz Schittenhelm, Jens Beschorner, Rudi Koch, Arend Thomale, Ulrich-Wilhelm Schuhmann, Martin Ulrich Children (Basel) Article Optic pathway gliomas in children carry significant morbidity and therapeutic challenges. For the subgroup of pre-chiasmatic gliomas, intraorbital and intradural resection is a curative option after blindness. We present a two-center cohort using different surgical approaches. A retrospective analysis was performed, including 10 children. Mean age at surgery was 6.8 years. Interval between diagnosis and surgery was 1–74 (mean 24 ± 5.5, median 10) months. Indications for surgery were exophthalmos, pain, tumor progression, or a combination. Eight patients underwent an extradural trans-orbital-roof approach to resect the intra-orbital tumor, including the optic canal part plus intradural pre-chiasmatic resection. Gross total resection was achieved in 7/8, and none had a recurrence. One residual behind the bulbus showed progression, treated by chemotherapy. In two patients, a combined supra-orbital mini-craniotomy plus orbital frame osteotomy was used for intraorbital tumor resection + intradural pre-chiasmatic dissection. In these two patients, remnants of the optic nerve within the optic canal remained stable. No patient had a chiasmatic functional affection nor permanent oculomotor deficits. In selected patients, a surgical resection from bulb to chiasm ± removal of optic canal tumor was safe without long-term sequela and with an excellent cosmetic result. Surgery normalizes exophthalmos and provides an effective tumor control. MDPI 2022-03-24 /pmc/articles/PMC9029433/ /pubmed/35455503 http://dx.doi.org/10.3390/children9040459 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zipfel, Julian
Tellermann, Jonas
Besch, Dorothea
Bertelmann, Eckart
Ebinger, Martin
Driever, Pablo Hernáiz
Schittenhelm, Jens
Beschorner, Rudi
Koch, Arend
Thomale, Ulrich-Wilhelm
Schuhmann, Martin Ulrich
Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm
title Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm
title_full Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm
title_fullStr Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm
title_full_unstemmed Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm
title_short Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function—Resection from Bulbus to Chiasm
title_sort surgical management of pre-chiasmatic intraorbital optic nerve gliomas in children after loss of visual function—resection from bulbus to chiasm
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9029433/
https://www.ncbi.nlm.nih.gov/pubmed/35455503
http://dx.doi.org/10.3390/children9040459
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