Surgical Management of an Optic Nerve Glioma with Perineural Arachnoidal Gliomatosis Growth Pattern

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Title Surgical Management of an Optic Nerve Glioma with Perineural Arachnoidal Gliomatosis Growth Pattern
Creator Chen, Aiyin; Yoon, Michael K; Haugh, Sarah; Phan, Laura T; Song, Jonathan; McCulley, Timothy J
Affiliation Department of Ophthalmology, University of California San Francisco, San Francisco, California; Massachusetts Eye and Ear Infirmary, Harvard University School of Medicine, Boston, Massachusetts; The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland; and King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Subject Arachnoid; Child; Exophthalmos; Female; Humans; Neuroglia; Optic Nerve; Optic Nerve Glioma; Treatment Outcome
Abstract We describe a vision sparing surgical approach for optic nerve glioma. A 7-year-old girl experienced declining academic performance and social withdrawal attributed to progressive disfiguring proptosis. Three years earlier, she had undergone a limited biopsy, a course of chemotherapy, and orbital radiation therapy for a right optic nerve glioma with perineural arachnoidal gliomatosis (PAG). Because of marked proptosis, another surgery was performed via a lateral orbitotomy. After cutting a window in the thickened dura of the optic nerve, rouge colored spongy tissue was suctioned from the subarachnoid space. Small, more solidified areas were excised with unipolar cautery. Care was taken to avoid identifiable blood vessels and the optic nerve, and approximately 60%-70% of the tumor was removed. The dural window was approximated with interrupted sutures. Postoperatively, there was 9 mm reduction in right proptosis and visual acuity improved to from 20/70 to 20/60. This case illustrates the possibility of debulki optic nerve gliomas without sacrificing vision. It should be stressed that this technique is only applicable to gliomas with PAG and the durability of the surgical benefit is unknown.
OCR Text Show
Date 2013-03
Type Text
Rights Management © North American Neuro-Ophthalmology Society
Publication Type Journal Article
ARK ark:/87278/s6gx7hp0
Setname ehsl_novel_jno
Date Created 2014-03-24
Date Modified 2014-07-10
ID 227378
Reference URL
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