Visual loss in children with neurofibromatosis type 1 and optic pathway gliomas

IF 4.1 1区 医学 Q1 OPHTHALMOLOGY
Laura J Balcer MD (MSCE) , Grant T Liu MD , Gordon Heller MD , Larissa Bilaniuk MD , Nicholas J Volpe MD , Steven L Galetta MD , Patricia T Molloy MD , Peter C Phillips MD , Anna J Janss MD, PhD , Sheila Vaughn (CRNP) , Maureen G Maguire PhD
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引用次数: 177

Abstract

PURPOSE: To examine the potential for visual acuity loss, and its relation to extent and location of optic pathway gliomas in a cohort of children with neurofibromatosis type 1 studied with magnetic resonance imaging.

METHODS: We reviewed the neuro-ophthalmologic records and brain/orbital magnetic resonance imaging scans for 43 consecutive pediatric patients with neurofibromatosis type 1 and optic pathway gliomas who were followed at the Children’s Hospital of Philadelphia. The presence of visual loss, defined as abnormal visual acuity for age in one or both eyes, was determined. Optic pathway gliomas were classified by tumor extent and location according to involvement of the optic nerves, chiasm, and postchiasmal structures by magnetic resonance imaging.

RESULTS: Involvement of the optic tracts and other postchiasmal structures at tumor diagnosis was associated with a significantly higher probability of visual acuity loss (P = .048, chi-square test). Visual loss was noted in 20 of 43 patients (47%) at a median age of 4 years; however, three patients developed visual acuity loss for the first time during adolescence.

CONCLUSIONS: In pediatric patients with neurofibromatosis type 1 and optic pathway gliomas, the likelihood of visual loss is dependent on the extent and location of the tumor by magnetic resonance imaging and is particularly associated with involvement of postchiasmal structures. Furthermore, older age during childhood (adolescence) does not preclude the occurrence of visual loss. Close follow-up beyond the early childhood years, particularly for those with postchiasmal tumor, is recommended.

1型神经纤维瘤病和视神经胶质瘤患儿的视力丧失
目的:通过磁共振成像研究1型神经纤维瘤病患儿视力丧失的可能性及其与视神经通路胶质瘤的范围和位置的关系。方法:我们回顾了在费城儿童医院连续随访的43例1型神经纤维瘤病和视神经通路胶质瘤患儿的神经眼科记录和脑/眶磁共振成像扫描。视力丧失的存在,定义为一只或两只眼睛的年龄视力异常。视神经胶质瘤通过磁共振成像根据累及视神经、视交叉及视交叉后结构,按肿瘤范围及部位进行分类。结果:肿瘤诊断时累及视束和其他交叉后结构与视力丧失的概率显著升高相关(P = 0.048,卡方检验)。43例患者中有20例(47%)出现视力丧失,中位年龄为4岁;然而,3例患者在青春期首次出现视力丧失。结论:在患有1型神经纤维瘤病和视神经通路胶质瘤的儿童患者中,视力丧失的可能性取决于磁共振成像显示的肿瘤的范围和位置,特别是与交叉后结构的受损伤有关。此外,儿童时期(青春期)的年龄较大并不排除视力丧失的发生。建议儿童早期以后密切随访,特别是对交叉后肿瘤患者。
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来源期刊
CiteScore
9.20
自引率
7.10%
发文量
406
审稿时长
36 days
期刊介绍: The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.
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