Endoscopic Transnasal Resection of Hypothalamic Pilocytic Astrocytoma

Background The management of optic pathway gliomas (OPGs) remains controversial. The role of surgery is debatable. When surgery is elected, these tumors are usually approached transcranially. Few cases of OPGs are reported in the literature that was resected utilizing an endoscopic endonasal approach (EEA).

Methods We retrospectively reviewed our cases of OPGs that were resected via an EEA. Clinical presentation, preoperative hormonal profiles, radiological and operative data, surgical complications, and visual outcomes are documented.

Results We present four cases of OPGs: three pediatrics and one adult patient. All cases presented with visual disturbance. The preoperative hormonal profiles were normal in all cases except for the adult patient, which had hypothyroidism. MRI of the brain demonstrated suprasellar intra-axial lesions. Tumors were resected utilizing the extended EEA. Closure was done using multiple layers. All tumors were WHO Grade I pilocytic astrocytomas. Gross total resection was achieved in one case. Surgical complications included hypopituitarism in two cases, meningitis in two cases, cerebrospinal fluid leak in one case, and transient diabetes insipidus in one case. Postoperative visual status remained unchanged in three cases and improved in one case as compared with the pre-operative visual assessment. The average length of hospital stay was 35 days.

Conclusion The EEA was performed successfully in four patients with progressive OPGs. Although surgery is rarely needed for OPG, the endonasal approach is a direct corridor which is emerging as a viable alternative to traditional transcranial approaches for these intra-axial tumors.