title: Complete recovery of visual functions after multimodality treatment for intrinsic chiasmatic-hypothalamic astrocytoma--case report.
abstract: A 21-year-old female was admitted with complaints of severe impairment of vision. The visual acuity was 0.02 in both eyes along with residual visual fields and central scotomas. Neuroimaging disclosed a chiasmatic-hypothalamic glioma. Surgery was performed with partial removal of the intrachiasmatic part of the intrinsic tumor. The histological diagnosis was fibrillary astrocytoma. Progressive recovery of vision began in the first week after surgery. Adjuvant treatment included one course of fractionated radiation therapy and six courses of chemotherapy. Complete recovery of visual acuity occurred after 10 months, and the visual fields were restored after an additional 6 months. Her vision has been stable during 2 years of follow up. The prognosis for recovery of vision after treatment of optic pathway gliomas mainly depends on the severity of visual loss at admission and is negatively influenced by intrinsic tumor growth, symmetrical extension, and involvement of the chiasm. Despite the presence of all these factors in the present case, multimodality management resulted in the complete recovery of visual functions. Surgery may be indicated in cases of intrinsic chiasmatic gliomas complicated by severe visual loss.
authors.affiliation: Department of Surgical Neurooncology, Russian A. L. Polenov Neurosurgical Institute, St. Petersburg, Russia. m_chernov@yahoo.com
authors.forename: Mikhail F
authors.initials: MF
authors.lastname: Chernov
authors.forename: Pavel I
authors.initials: PI
authors.lastname: Ivanov
authors.forename: Irina V
authors.initials: IV
authors.lastname: Zhinzhina
authors.forename: Oksana Yu
authors.initials: OY
authors.lastname: Getmanova
authors.forename: Julia M
authors.initials: JM
authors.lastname: Zabrodskaya
authors.forename: George S
authors.initials: GS
authors.lastname: Tigliev
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000150:complications / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000150:complications / Q000628:therapy*; D009897:Optic Chiasm; D019574:Optic Nerve Neoplasms / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014792:Visual Acuity