Radical resection of chiasmatic-hypothalamic
glioma (CHG) carries a significant risk of morbidity and the optimum treatment remains undecided. The authors reported 9 children with CHG, who were treated with surgical resection with or without postoperative
chemotherapy. Age at the time of diagnosis ranged from 4 months to 7.7 years (mean 3.1 years), and no patient had evidence of
neurofibromatosis type 1. Surgical resections of the
tumors were performed in all patients because of severe
visual impairment or
intracranial hypertension caused by large
tumors. All of the surgical interventions resulted in partial resections. Pathological examination revealed
pilocytic astrocytomas in 7 patients, low grade
astrocytoma in 1 and
anaplastic astrocytoma in 1. Seven patients with
residual tumors received postoperative
chemotherapy consisting of
cisplatin,
cyclophosphamide,
etoposide and
vincristine. Reduction in
tumor size was noticed in 5 patients, although 2 patients had no response and switched to local
radiotherapy. Although minor complications of
chemotherapy were noticed in 5 patients, severe sequelae such as neuropsychological deficits or endocrinopathies did not occur, and all patients completed
chemotherapy programs. Additional treatments are recommended in case of incomplete
tumor resections, because our experience demonstrates that the majority of the
residual tumors have potential to progress. Our present data suggests that the
chemotherapy of the aforementioned regimen is effective in controlling CHGs after partial resections and is relatively well tolerated even in young children who are vulnerable to
radiotherapy.