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The Analysis of Clinical Characteristics of Pediatric and Adult Optic Pathway Gliomas

Author: HuangGang
Tutor: YangZhengMing
School: Huazhong University of Science and Technology
Course: Surgery
Keywords: Optic pathway Glioma Children and adults Clinical characteristics Treatment
CLC: R739.4
Type: Master's thesis
Year: 2011
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Background and purpose:The anatomical structure of visual pathways is complex and adjacent to the important structure. This pathway of gliomas happened is relatively lower, but often involved more important anatomic structures. Visual pathways gliomas mainly happend in children, relatively few in adults . This disease has a very low preoperative diagnosis rate. At present, the main treatment is surgery and postoperative radiotherapy and(or) chemotherapy in clinical. Such treatment is sameness and often lacks pertinence. This article mainly discusses the differences of pediatric and adult OPG, in order to improve the diagnosis level and targeted therapy of OPG , so as to improve the prognosis of patients.Material and method:Detailedly study the relevant anatomy of optic pathway and retrospectively analyze the clinical data of 24 patients that we receive and cure in the past nine years. All patients into the group of pediatric and the group of adult. Analyse and compare the differences of clinical manifestations, cancer growth parts and imaging manifestations, diagnosis, treatment, and prognosis pathology results in two groups of patients.Results:This 24 patients include 13 cases of children with an average age of 8.5 years (1~14 years old) and 11 cases of adults with the average age of 31.5 years(15~50 years old). All of patients had no neurofibromatosis type 1(NF-1) and had impaired vision. The pediatric group: 2 had protopsis; 8 had visual field defects; 4 had endocrine symptoms; 2 had epilepsy; 5 had intracranial pressure heighten;4 had hydrocephalus. The type of intro-orbital optic nerve had 2 cases; The type of optic chiasma had 9 cases; The type of chiasma -hypothalamus diffuse had 2 cases. Preoperatively consider glioma had 5 cases. Treatment: 1 case without any treatment. 12 cases had surgical treatment; 7 cases had full resection and most resection; 4 cases had partial resection; 1 case had biopsy. Postoperative radiotherapy had 1 case; postoperative radiotherapy and chemotherapy had 1 case. Pathology results: Pilocytic astrocytoma(PA) had 4 cases; Astrocytomas grⅠ~Ⅱhad 3 cases; Astrocytomas grⅡhad 3 cases; Ganglioglioma grⅡhad 2 cases. To report date, imaging progression-free is 5 cases; The clinical symptoms without progress is 6 cases; The recurrence and healer again is 1 case; The death is 1 case. The adult group: 4 had visual field defects; 7 had endocrine symptoms; 2 had epilepsy; 7 had intracranial pressure heighten; 7 had hydrocephalus. The type of intro-orbital optic nerve had 0 cases; The type of optic chiasma had 5 cases; The type of chiasma-hypothalamus diffuse had 6 cases. Preoperatively consider glioma had 4 cases. Treatment:11 cases had surgical treatment; 7 cases(3 cases is dead) had full resection and most resection; 4 cases had partial resection. Postoperative radiotherapy had 3 cases; postoperative radiotherapy and chemotherapy had 3 cases. Pathology results: Pilocytic astrocytoma(PA) had 4 cases; Pilomyxoid astrocytoma (PMA) had 1 cases; Astrocytomas grⅠhad 2 cases; Fibrillary astrocytoma grⅠ~Ⅱhad 1 case; Astrocytomas grⅠ~Ⅱhad 1 case; Astrocytomas grⅡhad 1 case(GFAP tumor cell diffuse positive ); Ganglioglioma grⅡhad 2 cases; Astrocytomas grⅡ~Ⅲhad 1 case. Imaging progression-free until the date to report is 2 cases; The clinical symptoms without progress is 2 cases; The recurrence and healer again is 4 cases; The death is 3 cases.Conclusion:OPG has a low preoperative diagnosis rate. We need depend on patients with clinical, radiological material and ophthalmologic examination to improve the diagnostic level. The pediatric OPG easily occurs in optic never and optic chiasma and the main clinical manifestations is visual impairment .The tumor involves small range and have a good properties . The effect of operation is not good. After 10 years old children can have a postoperative radiotherapy. The pediatric OPG have a good prognosis. The adult OPG easily occurs in optic chiasma and chiasma–hypothalamus and the main clinical manifestations is endocrine symptoms and intracranial pressure heighten. The operation effect is poorer and the tumor properties not good enough. The patients need postoperative radiotherapy and chemotherapy mostly. The prognosis more bad than children.

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