Neuro-ophthalmic sequelae of pediatric brain tumors

Abstract

Brain tumors are a leading cause of mortality and morbidity in the pediatric population. Neuro-ophthalmic symptoms can be a consequence of the disease process, as well as a feature of long-term complications from treatment. Compressive lesions of the visual pathway lead to changes in visual acuity and field defects. Double vision and strabismus can be some of the earliest clues of underlying posterior fossa tumors, which frequently cause hydrocephalus and manifest as optic nerve edema on neuro-ophthalmic examination due to increased intracranial pressure. Persistent complaints of blurry vision in combination with nonspecific neurologic concerns warrant ophthalmoscopy to appreciate optic nerve appearance and magnetic resonance imaging as the earliest steps in the investigation of possible compressive or infiltrative malignancies. In many cases, treatment of pediatric brain tumors relies on maximal surgical resection and radiation, which can have permanent consequences not only affecting the patients’ visual function but also their neurologic development. This review will summarize the neuro-ophthalmic presentations and consequences of pediatric tumors affecting the brain, highlighting classic neuro-ophthalmic correlates and describing the known sequelae of tumor progression or treatment.