We describe a vision sparing surgical approach for
optic nerve glioma. A 7-year-old girl experienced declining academic performance and social withdrawal attributed to progressive disfiguring
proptosis. Three years earlier, she had undergone a limited biopsy, a course of
chemotherapy, and orbital
radiation therapy for a right
optic nerve glioma with perineural arachnoidal gliomatosis (PAG). Because of marked
proptosis, another surgery was performed via a lateral orbitotomy. After cutting a window in the thickened dura of the optic nerve, rouge colored spongy tissue was suctioned from the subarachnoid space. Small, more solidified areas were excised with unipolar
cautery. Care was taken to avoid identifiable blood vessels and the optic nerve, and approximately 60%-70% of the
tumor was removed. The dural window was approximated with interrupted
sutures. Postoperatively, there was 9 mm reduction in right
proptosis and visual acuity improved to from 20/70 to 20/60. This case illustrates the possibility of debulking
optic nerve gliomas without sacrificing vision. It should be stressed that this technique is only applicable to
gliomas with PAG and the durability of the surgical benefit is unknown.