TY - JOUR
T1 - Optic pathway-hypothalamic glioma hemorrhage
T2 - A series of 9 patients and review of the literature
AU - Van Baarsen, Kirsten
AU - Roth, Jonathan
AU - Serova, Natalia
AU - Packer, Roger J.
AU - Shofty, Ben
AU - Thomale, Ulrich W.
AU - Cinalli, Giuseppe
AU - Toledano, Helen
AU - Michowiz, Shalom
AU - Constantini, Shlomi
N1 - Publisher Copyright:
© 2018 American Association of Neurological Surgeons. All rights reserved.
PY - 2018
Y1 - 2018
N2 - OBJECTIVE Hemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases. METHODS A total of 34 patients were analyzed. Nine new cases were collected, and 25 were identified in the literature. Data regarding demographics, radiological and histological features, treatment, and outcome were retrospectively reviewed. RESULTS The majority of patients were younger than 20 years. Only 3 patients were known to have neurofibromatosis. The histopathological diagnosis was pilocytic astrocytoma in the majority of cases. Five patients had intraorbital hemorrhages, whereas 29 patients had intracranial hemorrhage; the majority of intracranial bleeds were treated surgically. Six patients, all with intracranial hemorrhage, died due to recurrent bleeding, hydrocephalus, or surgical complications. No clear risk factors could be identified. CONCLUSIONS Intracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.
AB - OBJECTIVE Hemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases. METHODS A total of 34 patients were analyzed. Nine new cases were collected, and 25 were identified in the literature. Data regarding demographics, radiological and histological features, treatment, and outcome were retrospectively reviewed. RESULTS The majority of patients were younger than 20 years. Only 3 patients were known to have neurofibromatosis. The histopathological diagnosis was pilocytic astrocytoma in the majority of cases. Five patients had intraorbital hemorrhages, whereas 29 patients had intracranial hemorrhage; the majority of intracranial bleeds were treated surgically. Six patients, all with intracranial hemorrhage, died due to recurrent bleeding, hydrocephalus, or surgical complications. No clear risk factors could be identified. CONCLUSIONS Intracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.
KW - Apoplexy
KW - Astrocytoma
KW - Blindness
KW - Hemorrhage
KW - Hypothalamic glioma
KW - Low-grade glioma
KW - Neurofibromatosis
KW - Oncology
KW - Optic glioma
KW - Third ventricle
UR - http://www.scopus.com/inward/record.url?scp=85059495869&partnerID=8YFLogxK
U2 - 10.3171/2017.8.JNS163085
DO - 10.3171/2017.8.JNS163085
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C2 - 29424646
AN - SCOPUS:85059495869
SN - 0022-3085
VL - 129
SP - 1407
EP - 1415
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 6
ER -