ANALYSIS OF 20 PRIMARILY SURGICALLY TREATED CHIASMATIC HYPOTHALAMIC PILOCYTIC ASTROCYTOMAS

The authors review the therapeutic results of 20 patients (aged 12 mon ths to 30 years, mean age 9 years) with benign pilocytic astrocytoma o f the chiasmatic/hypothalamic region, seen at the University Hospital Hamburg-Eppendorf between February 1980 and April 1993. Six patients s uffered from neurofibromatosis 1 (NF-1). The patients were divided int o two subgroups relative to tumour extension and growth patterns, as r evealed by CT scans and/or MR imaging. Fourteen patients revealed a la rge globular suprasellar tumour extending into the hypothalamus and/or the anterior third ventricle (group A). A suprasellar tumour with opt ic tract involvement could be identified in six cases (group B). Subto tal (70-90%) resection was achieved in ten tumours (50%), the majority of which were of the large globular type. There were no deaths. Posto perative morbidity was comprised of visual and endocrine impairment in four patients and right hemiparesis and dysphasia in one patient. Rad iation therapy was given in nine cases (45%). Three tumours (38%) were reduced in size by irradiation. Tumour progression was seen in seven patients (35%). The presence of young age and NF-1 were predictors of progressive disease in our series. Growth capacity was not related to the extent of cytoreductive surgery.