Craniopharyngioma with optic canal enlargement simulating glioma of the optic chiasm

Block, Michael H.; Goree, John A.; Jimenez, John P.

doi:10.3171/jns.1973.39.4.0523

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…Our experience with diencephalic gliomas in children is consistent with previous reports that noted a poorer prognosis of posteriorly placed lesions involving the chiasm, hypothalamus, or thalamus [16,20], Clinical features that suggest a diagnosis of diencephalic glioma preoperatively are visual in volvement without hypopituitarism or diabetes insipidus; hydrocephalus and papilledema occur more frequently in these patients [24], The radiologic ap pearance of these tumors often closely resembles that of parasellar germino mas and occasionally that of a solid noncalcified craniopharyngioma [1], making biopsy verification essential. In our series, patients with chiasmal, hypothalamic, or thalamic gliomas received radiation therapy.…”

Section: Discussionsupporting

confidence: 76%

Parasellar Tumors in Children

Richmond¹,

Wilson²

1980

Pediatr Neurosurg

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Despite the predominance of histologically benign tumors in the parasellar region of children, their proximity to the hypothalamus, optic nerves and tracts, and the internal carotid artery and its branches often renders surgical removal exceptionally difficult. The possible presence of a variety of tumor types makes biopsy verification of tumor diagnosis essential. The surgical management, radiotherapeutic treatment, and clinical follow-up of a group of 74 children whose preoperative findings were reviewed in the preceding paper are presented to illustrate the management of four major tumor types encountered: craniopharyngioma, pituitary adenoma, germinoma, and diencephalic glioma. Both subfrontal and transsphenoidal surgical approaches were used. Although total resection of benign tumors is desirable, prudent use of a variety of techniques can achieve effective neurosurgical management and optimal long-term results.

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Section: Discussionsupporting

confidence: 76%

Parasellar Tumors in Children

Richmond¹,

Wilson²

1980

Pediatr Neurosurg

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“…Pure enlargement of the foramen without erosion or hyperostosis is most likely due to optic nerve glioma. Similar findings in children may be produced by infiltration of the optic nerve in retinoblastoma or sarcoidosis (Anderson et al, 1966), intracanalicular extension of a neurofibroma, craniopharyngioma (Block et al, 1973), or ectopic pinaeloma (germinoma) (Cohen et al, 1974). Enlargement of the optic canal has been described in two adults with suprasellar cholesteatomas (Olivecrona, 1932), one of which however had pressure resorption of bone at the foraminal margin.…”

Section: Roentgenographic Featuresmentioning

confidence: 62%

Tumors of the optic nerve

1976

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This is a review of primary and secondary tumors of the optic nerve. The emphasis is an optic nerve gliomas and meningiomas. Optic nerve gliomas are slowly growing astrocytic neoplasms of the anterior visual pathways, the majority of which occur within the first two decades of life, with equal sex incidence in about 1 of 200,000 patients presenting with eye complaints. The incidence is greater in neurofibromatosis. The typical presentation is visual impairment in a verbal pre-school child with optic canal enlargement and optic atrophy. An intraorbital location of the tumor leads to axial, irreducible, non-pulsatile proptosis. An intracranial location may disturb hypothalamic and pituitary function and produce hydrocephalus. Ocular findings may also include limited motility on a mechanical-restrictive basis, a pupillary relative afferent defect, nystagmus, and variable, non-specific visual field defects. Roentgenographic studies may show concentric unilateral enlargement of the optic canal with preservation of a well corticated margin, a fossa under the anterior clinoid process in continuity with the optic canal ('J'-shaped sella), and findings of increased intracranial pressure. On pathologic examination the tumor is a smooth, fusiform, intradural enlargement of the optic nerve. Histologically there is proliferation of elongated (pilocytic) astrocytes in reticulated patterns with intervening microcystic spaces containing mucosubstance and surrounding reactive hyperplasia of the arachnoid. Mitoses are not found. The diagnosis is clinical X-ray studies and brain scan should be performed. The differential diagnosis is that of unilateral proptosis in a child and includes acute ethmoiditis, hyperthyrobidism, craniostenosis, other neoplasms, Hand-Schuller-Christian disease, and orbital hemorrhage due to trauma. Surgical resection is performed in cases with unilateral optic nerve involvement, the surgical approach being determined by tumor location. Bilateral or chiasmal cases are treated with radiotherapy when progression occurs. Malignant optic nerve gliomas and optic nerve hyperplasia are also discussed. Optic nerve meningiomas arise from the nerve sheath and are to be distinguished from orbital meningiomas arising from ectopic arachnoidal cells or those secondarily involving the orbit by extension from adjacent sites. Up to 80% of orbital meningiomas occur in females, in two age peaks, 25% in the first decade, and the rest in the 5th decade. Meningiomas present with visual loss and may produce proptosis, papilledema and/or optic atrophy, retinal striae, opticociliary shunts, limitation of extra-ocular movements, and lid edema, Signs of von Recklinghausen's disease should be sought. X-rays are the mainstay of diagnosis. Orbital meningiomas are composed of cells in sheets or in whorls with some spindle shaped cells. Calcifications are typical. Usually the dura is penetrated and the orbit invaded. Primary orbital meningiomas are locally infiltrating but do not metastasize. Complete local excision en bloc is recommended...

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“…The traditional neuroradiologic evidence of a chiasmal tumor is usually limited to that of a suprasellar lesion [18,24], The same evidence can be mimicked by more than one type of lesion [14], such as histiocytosis X [64], sarcoidosis [52], lymphoma and inflammatory diseases of the optic structures [30. 32, 33.47], suprasellar germinoma [8] and even others (craniopharyngioma [3], meningiomas [12,60,65,68,69,72] and pituitary adenomas) the amenability of which to an effective neurosurgical operation seems less disputed. In the impossibility of being dogmatic about diagnosis, it seems even less possible to accept dogma as to treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted, however, that even the CT scan is by no means infallible [3,60,68,69,72,75,78]. Its great advantage is that it visualizes before surgery the true extent of the tumor and its involvement of structures neighbouring the chiasm, an information that once was available only from gross operative findings; it also helps in assessing the possible indi cation for a CSF shunt and.…”

Section: Discussionmentioning

confidence: 99%

Gliomas of the Optic Nerve and Chiasm

Iraci¹,

Gerosa²,

Tomazzoli³

et al. 1981

Pediatr Neurosurg

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A series of 24 children with anterior optic gliomas, observed and for the most part operated upon in a neurostirgical service, is reviewed. A low incidence of unilateral nerve tumors and of associated neurofibromatosis, and a rather high frequency of precocious or pseudoprecocious puberty were noted in comparison with other series. Most tumors were low-grade growths. The results of surgical treatment reflect a good prognosis for unilateral tumors and an increasing prognostic ominousness for the posterior neoplastic development. Cerebrospinal fluid shunts and radiation treatment do have a role as adjuncts to surgical exploration and biopsy, which are generally indicated since no preoperative test seems to grant an absolute diagnosis. The opinion that chiasmal tumors should not be treated at all is not shared.

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Craniopharyngioma with optic canal enlargement simulating glioma of the optic chiasm

Abstract: ✓ A case of bilateral enlargement of the optic canals by a craniopharyngioma is documented, and the differential diagnosis from optic glioma is discussed.

Cited by 13 publications

References 8 publications

Parasellar Tumors in Children

Parasellar Tumors in Children

Tumors of the optic nerve

Gliomas of the Optic Nerve and Chiasm

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