Gliomas of the optic nerve and chiasm. A clinical review

A series of 24 children with anterior optic gliomas, observed and for the most part operated upon in a neurosurgical service, is reviewed. A low incidence of unilateral nerve tumors and of associated neurofibromatosis, and a rather high frequency of precocious or pseudoprecocious puberty were noted in comparison with other series. Most tumors were low-grade growths. The results of surgical treatment reflect a good prognosis for unilateral tumors and an increasing prognostic ominousness for the posterior neoplastic development. Cerebrospinal fluid shunts and radiation treatment do have a role as adjuncts to surgical exploration and biopsy, which are generally indicated since no preoperative test seems to grant an absolute diagnosis. The opinion that chiasmal tumors should not be treated at all is not shared. When the treatment of an illness falls as far short of the ultimate, as does the therapy of neoplastic disease, then it is necessary to reconsider frequently the principles upon which it is based and the results it achieves. These results are two-fold, curative and palliative and, while our efforts are directed toward the former, we realize only too frequently that the best results will sometimes lie in palliation. The disappointment in accepting this lesser goal must not allow us to underestimate its importance or neglect the help it may give.