Didier Frappaz1, Claire Pedone1, Philippe Thiesse2, Alexandru Szathmari3, Cécile Faure Conter1, Carmine Mottolese3, Christian Carrie4. 1. Department of Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France. 2. Department of Radiology, Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France. 3. Department of Neurosurgery, Hospital Wertheimer, Bron, France. 4. Department of Radiotherapy, Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France.
Abstract
OBJECTIVE: Patients with brain tumors often report having visual complaints. This may be due to increased intracranial pressure, compression/invasion of the optic pathway or diplopia. We assessed the incidence and the etiology of visual symptoms in patients with intracranial germinoma tumors (ICGTs). METHODS AND MATERIALS: We performed a blinded retrospective review of the clinical charts and the initial magnetic resonance imaging (MRI) of 28 patients with ICGT. Thirteen tumors were pineal, five suprasellar, seven bifocal, and further three involved either the optic nerve, the corpus callosum, or the brainstem. RESULTS: Twelve patients reported visual disturbances, seven of whom mainly experienced a decrease in vision. Two of those were initially managed as "retrobulbar neuritis" when endocrinologic symptoms prompted assessment by MRI. Involvement of the optic pathway was underestimated, and both relapsed. Field deficits were definitive sequelae, whereas visual acuity was sometimes regressive in the absence of optic atrophy. CONCLUSIONS: Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.
OBJECTIVE:Patients with brain tumors often report having visual complaints. This may be due to increased intracranial pressure, compression/invasion of the optic pathway or diplopia. We assessed the incidence and the etiology of visual symptoms in patients with intracranial germinoma tumors (ICGTs). METHODS AND MATERIALS: We performed a blinded retrospective review of the clinical charts and the initial magnetic resonance imaging (MRI) of 28 patients with ICGT. Thirteen tumors were pineal, five suprasellar, seven bifocal, and further three involved either the optic nerve, the corpus callosum, or the brainstem. RESULTS: Twelve patients reported visual disturbances, seven of whom mainly experienced a decrease in vision. Two of those were initially managed as "retrobulbar neuritis" when endocrinologic symptoms prompted assessment by MRI. Involvement of the optic pathway was underestimated, and both relapsed. Field deficits were definitive sequelae, whereas visual acuity was sometimes regressive in the absence of optic atrophy. CONCLUSIONS: Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.
Authors: Myrthe A Nuijts; Inge Stegeman; Tom van Seeters; Marloes D Borst; Carlien A M Bennebroek; Dennis R Buis; Nicole C Naus; Giorgio L Porro; Michelle B van Egmond-Ebbeling; Elisabeth S M Voskuil-Kerkhof; JanWillem R Pott; Niels E Franke; Evelien de Vos-Kerkhof; Eelco W Hoving; Antoinette Y N Schouten-van Meeteren; Saskia M Imhof Journal: JAMA Ophthalmol Date: 2022-10-01 Impact factor: 8.253