Visual complaints in intracranial germinomas

Frappaz, Didier; Pedone, Claire; Thiesse, Philippe; Szathmari, A.; Conter, Cécile Faure; Mottolèse, C.; Carrié, C.

doi:10.1002/pbc.26543

Cited by 15 publications

(24 citation statements)

References 22 publications

(21 reference statements)

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“…In patients with pineal gland lesions, diplopia seems the most common, while visual acuity and field impairment occurred more often when sellar/suparsellar region involved. In a retrospective study including 28 iGCTs, 12 (42.8%) patients reported visual disturbances [19]. In 7 patients that suffered from visual acuity loss, 5 (71.4%) had suprasellar involvement.…”

Section: Discussionmentioning

confidence: 99%

Emergency irradiation of 3.4Gy/2f in pineal gland germinoma patients with symptomatic hydrocephalus

et al. 2019

Chin Neurosurg Jl

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Background: Surgical interventions including ventriculostomy and ventriculo-peritoneal shunt were usually administrated in pineal germ cell tumor patients with symptomatic hydrocephalus. Considering higher sensitivity of germinoma to anti-tumor therapy, we explored emergency irradiation as non-invasive measure in this situation. Methods: Data of 35 germinoma patients with symptomatic hydrocephalus who received emergency irradiation of 3. 4 Gy/2f were studied retrospectively. The maximum width of frontal horn and the minimum width of trunk of corpus callosum (TCC) were measured to evaluate hydrocephalus changing. Besides, mean deviation (MD) of Humphrey perimetry was employed to evaluate visual field defect. Correlations between hydrocephalus changing and clinical factors, including age, percentage of tumor regression, radiographic re-evaluation interval, and serum beta-human chorionic gonadotropin (β-HCG) level, were analyzed. Results: The median maximum diameter and volume of pineal lesions was 27 mm (range 10-55 mm) and 6.5cm 3 (range 0.4-74.1 cm 3), respectively. At median 8 days after irradiation, the median percentage of tumor remission was 55% (range 10-100%). The median maximum width of FN and the median minimum width of TCC were 11.6 mm and 39.0 mm, and 8.0 mm and 31.4 mm, before and after irradiation, respectively. The improvement of both parameters reached significant level (p < 0.001). However, none clinical factor was found to have correlation with their improvement. In 14 patients with paired data of pre-and post-irradiation MD, its change did not reach the significant level for both eyes. All patients successfully received subsequent chemoradiotherapy without surgical intervention. Conclusions: Emergency irradiation of 3.4 Gy/2f was an effective non-invasive measure to relief hydrocephalus in pineal germinoma patients.

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Section: Discussionmentioning

confidence: 99%

Emergency irradiation of 3.4Gy/2f in pineal gland germinoma patients with symptomatic hydrocephalus

et al. 2019

Chin Neurosurg Jl

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“…The most common manifestation of germinoma is polyuria, while mass symptoms in the form of headache and visual complaints are observed in approximately half of the cases[ 6 ]. The visual complaints always occur after DI, with a median delay of 5 mo (ranging from 1 to 35)[ 3 ]. The common mechanisms that lead to visual loss include the following aspects[ 3 ]: (1) Intracranial space mass causing intracranial hypertension and papilledema; (2) Compression of the optic chiasma by the sellar mass; and (3) Primary tumor/tumor invasion of the optic nerve, optic radiation, and occipital cortex.…”

Section: Discussionmentioning

confidence: 99%

“…Germinoma most frequently arises in the midline axis of the brain (especially in the pineal and suprasellar regions)[ 2 ]. Extra-axial sites have been reported, mostly in Asian populations, in the thalamic and basal ganglia, corpus callosum, and ventricles[ 3 ]. Clinical manifestations as well as associated endocrine abnormalities depend on the location and size of the tumor.…”

Section: Introductionmentioning

confidence: 99%

Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding: A case report

Yang¹,

Zhu²,

Yao³

et al. 2021

WJCC

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BACKGROUND Germinoma is a type of germ cell tumor that most frequently arises in the midline axis of the brain. Impaired vision is a clinical manifestation of germinnoma. Although rare, intracranial germinoma seeding to the perioptic arachnoid space is one cause of visual acuity decrease. CASE SUMMARY An 11yearold girl who presented with polyuria and polydipsia and subsequently developed diminution of vision. Imaging showed bilateral heterogeneous enhancement of the optic nerve sheaths and atrophy of the optic nerve, and transsphenoidal biopsy revealed a germinoma. The patient experienced poor visual recovery following chemotherapy and radiotherapy. Germinomas are rare and they are mostly identified in children and adolescents. The manifestations include diabetes insipidus, pituitary dysfunction, visual complaints, etc. The mechanisms that lead to visual loss include intracranial hypertension, compression of optic chiasma, and tumor invasion. A literature review was performed to summarize the cases with a tumor infiltrating the optic nerve. Most of the reported patients were adolescents and presented with anterior pituitary hormone deficiency. Enhancement of optic nerve sheaths and optic disc pallor could be identified in most of the cases. The purpose of this report is to provide awareness that in cases where a germinoma is associated with visual loss, though rare, perioptic meningeal seeding should be taken into consideration. CONCLUSION The case report suggests that children with diabetes insipidus need a complete differential diagnosis.

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“…As a result, this condition received minimal attention until visual function decreased dramatically due to rapid progression of the intra-cranial tumor mass in certain patients. In a study conducted by Frappaz et al , [6] among seven patients who suffered vision loss, five had suprasellar lesions. In another study including 16 patients with sellar/suprasellar gernimoma, eight had visual complaints.…”

Section: Discussionmentioning

confidence: 99%

“…[4,5] Visual function impairments such as visual acuity (VA) decline and visual field defects were common complaints from patients with sellar/suprasellar germinoma. [6,7] Furthermore, certain patients experienced rapid VA deterioration due to rapid progression of tumor cells. In clinical practice, this situation must be addressed immediately to avoid irreversible loss of visual function.…”

Section: Introductionmentioning

confidence: 99%

Emergency irradiation with 3.4 Gy/2f in sellar/suprasellar germinoma patients with rapid visual acuity decline

et al. 2019

Chinese Medical Journal

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Background:Rapid visual acuity (VA) decline was a common complaint in patients with sellar/suprasellar germinoma. In our hospital, 3.4 Gy/2f of emergency irradiation was applied to save patient VA and enable subsequent chemoradiotherapy. This study aimed to investigate the efficacy of emergency irradiation with 3.4 Gy/2f in patients with sellar/suprasellar germinoma who had rapid VA decline.Methods:From January 2014 to December 2017, 33 patients with sellar/suprasellar germinoma who complained of VA decline within 3 months received 3.4 Gy/2f of emergency irradiation in Beijing Tiantan Hospital. The best-corrected VA (BCVA) and mean deviation (MD) were measured. Correlations between visual function change and clinical factors, including age at diagnosis, duration of VA decline, extent of tumor regression, serum level of tumor markers, were analyzed.Results:Among 33 patients with sellar/suprasellar germinoma, the median diameter and volume of sellar/suprasellar lesions were 32 mm (range: 5–55 mm) and 12.9 cm3 (range 0.6–58.5 cm3), respectively. Data on pre- and post-emergency-irradiation BCVA were obtained in 32 patients. For the right eyes, BCVA was improved in 23 patients (71.9%), unchanged in 7 (21.9%), and worsened in 2 (6.2%); and for the left eyes, these numbers were 27 (84.4%), 4 (12.5%), and 1 (3.1%), respectively. In terms of the logarithm of the minimum angle of resolution (logarithm of the minimum angle of resolution = Log (1/BCVA) score, the improvement was significant in both eyes (P < 0.001). In terms of MD, six patients had paired data and the improvement was marginal in the right eyes (P = 0.068) and significant in the left eyes (P = 0.043). However, no clinical factor was found to have correlation with visual function improvement.Conclusion:In sellar/suprasellar germinoma patients with VA decline, 3.4 Gy/2f of emergency irradiation was effective in improving visual function.

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Visual complaints in intracranial germinomas

Abstract: Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.

Cited by 15 publications

References 22 publications

Emergency irradiation of 3.4Gy/2f in pineal gland germinoma patients with symptomatic hydrocephalus

Emergency irradiation of 3.4Gy/2f in pineal gland germinoma patients with symptomatic hydrocephalus

Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding: A case report

Emergency irradiation with 3.4 Gy/2f in sellar/suprasellar germinoma patients with rapid visual acuity decline

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