Surgical treatment of anterior visual pathway gliomas in children using intraoperative neurophysiological monitoring and MR tractography

Authors:

Николай Иванович Головин,

Сергей Кириллович Горелышев,

Анна Анатольевна Огурцова,

Рамин Малик оглы Афандиев

Журнал: Вопросы нейрохирургии имени Н.Н. Бурденко. 2026;90(5):54-60.

DOI: 10.17116/neiro20269005154

Read: 656 раз

Download PDF (EN)

Abstract

BACKGROUND

Surgical resection of anterior visual pathway gliomas carries a high risk of postoperative visual deficit. The goals of surgical treatment are maximum safe removal of tumor and histological verification. Diffusion tensor imaging (DTI) with reconstruction of visual pathways and intraoperative monitoring of visual evoked potentials (VEP) were proposed to reduce the risk of potential visual dysfunction.

OBJECTIVE

To demonstrate two cases of surgical treatment for anterior visual pathway gliomas using preoperative MR tractography of visual pathways and intraoperative VEP monitoring.

MATERIAL AND METHODS

Two patients with anterior visual pathway tumors underwent preoperative MR tractography of visual pathways. Intraoperative VEP monitoring was performed.

RESULTS

Extent of resection in both cases was determined by preoperative MR tractography and intraoperative neurophysiological monitoring of VEP. Ophthalmological status in early postoperative period demonstrated positive dynamics in the 1^st patient and no changes in the 2^nd patient.

CONCLUSION

Preoperative MR tractography of visual pathways and intraoperative neurophysiological monitoring of VEP with electrophysiological identification of visual pathways may potentially enable safer tumor resection and minimize the risk of postoperative visual deficit.

Keywords

optic pathway glioma
MR tractography
intraoperative neurophysiological monitoring of VEP

Конфликт интересов

The authors declare no conflicts of interest.

Дата поступления: 04.06.2026

Дата принятия в печать: 20.07.2026

Дата публикации: 16.10.2026

References

Elzaafarany O, Elhomosany S, Rincones A, Dlugi V, Mokhtari S. Optic Pathway Glioma: Current Treatment Approaches and Ongoing Clinical Trials. Brain Sciences. 2025;15(8):894. https://doi.org/10.3390/brainsci15080894
Amato A, Imbimbo BP, Falsini B. Neurofibromatosis type 1-associated optic pathway gliomas: pathogenesis and emerging treatments. European Review for Medical and Pharmacological Sciences. 2023;27(12):5636-5653. https://doi.org/10.26355/eurrev_202306_32804
Chen Y, Yu J, Ge S, Jia R, Song X, Wang Y, Fan X. An Overview of Optic Pathway Glioma With Neurofibromatosis Type 1: Pathogenesis, Risk Factors, and Therapeutic Strategies. Investigative Ophthalmology & Visual Science. 2024;65(6):8. https://doi.org/10.1167/iovs.65.6.8
Kim JW, Phi JH, Kim SK, Lee JH, Park SH, Won JK, Choi JY, Kang HJ, Park CK. Comparison of the clinical features and treatment outcomes of pilocytic astrocytoma in pediatric and adult patients. Child’s Nervous System. 2023;39(3):583-591. https://doi.org/10.1007/s00381-023-05839-x
Modrzejewska M, Olejnik-Wojciechowska J, Roszyk A, Szychot E, Konczak TD, Szemitko M, Peregud-Pogorzelski JW. Optic Pathway Gliomas in Pediatric Population-Current Approach in Diagnosis and Management: Literature Review. Journal of Clinical Medicine. 2023;12(21):6709. https://doi.org/10.3390/jcm12216709
Yaman Bajin I, Bouffet E. Optic pathway and hypothalamic glioma, old problems, new paradigms. Pediatric Hematology Oncology Journal. 2023; 8(2):102-110. https://doi.org/10.1016/j.phoj.2023.04.003
Li S, Xiao W, Tong Z, Li L, Zhang Y. The Use of Diffusion Tensor Imaging in the Differentiation and Surgical Planning of Suprasellar Hypothalamic-Opticochiasmatic Glioma and Craniopharyngioma in Children. World Neurosurgery. 2024;193:474-482. https://doi.org/10.1016/j.wneu.2024.09.074
Carrozzi A, Gramegna LL, Sighinolfi G, Zoli M, Mazzatenta D, Testa C, Lodi R, Tonon C, Manners DN. Methods of diffusion MRI tractography for localization of the anterior optic pathway: A systematic review of validated methods. NeuroImage: Clinical. 2023;39:103494. https://doi.org/10.1016/j.nicl.2023.103494
Soumpasis C, Díaz-Baamonde A, Ghimire P, Baig Mirza A, Borri M, Jarosz J, Gullan R, Ashkan K, Bhangoo R, Vergani F, Lavrador JP, Mirallave Pescador A. Intraoperative Neuromonitoring of the Visual Pathway in Asleep Neuro-Oncology Surgery. Cancers. 2023;15(15):3943. https://doi.org/10.3390/cancers15153943
Guzzi G, Ricciuti RA, Della Torre A, Lo Turco E, Lavano A, Longhini F, La Torre D. Intraoperative Neurophysiological Monitoring in Neurosurgery. Journal of Clinical Medicine. 2024;13(10):2966. https://doi.org/10.3390/jcm13102966
Olmsted ZT, Silverstein JW, Einstein EH, Sowulewski J, Nelson P, Boockvar JA, D’Amico RS. Evolution of flash visual evoked potentials to monitor visual pathway integrity during tumor resection: illustrative cases and literature review. Neurosurgical Review. 2023;46(1):46. https://doi.org/10.1007/s10143-023-01955-z
Kim JW, Kim SK. The role of surgery for optic pathway gliomas in the era of precision medicine. Child’s Nervous System. 2024;40(10):3075-3083. https://doi.org/10.1007/s00381-024-06450-4
Karbe AG, Gorodezki D, Schulz M, Tietze A, Gruen A, Driever PH, Schuhmann MU, Thomale UW. Surgical options of chiasmatic hypothalamic glioma-a relevant part of therapy in an interdisciplinary approach for tumor control. Child’s Nervous System. 2024;40(10):3065-3074. https://doi.org/10.1007/s00381-024-06498-2
Bertalanffy H, Gallieni M, Mahmoodi R, Fahlbusch R, Kar S, Di Rocco C. Surgical Treatment of Optic Pathway Hypothalamic Gliomas. Advances and Technical Standards in Neurosurgery. 2025;55:17-45. https://doi.org/10.1007/978-3-031-90762-3_2
Samples DC, Mulcahy Levy JM, Hankinson TC. Neurosurgery for Optic Pathway Glioma: Optimizing Multidisciplinary Management. Frontiers in Surgery. 2022;9:884250. https://doi.org/10.3389/fsurg.2022.884250
Hill CS, Khan M, Phipps K, Green K, Hargrave D, Aquilina K. Neurosurgical experience of managing optic pathway gliomas. Child’s Nervous System. 2021;37(6):1917-1929. https://doi.org/10.1007/s00381-021-05060-8
Albalkhi I, Shafqat A, Bin-Alamer O, Mallela AN, Gersey ZC, Fernandes Cabral D, Sabbagh AJ, Hadjipanayis CG, González-Martínez JA, Friedlander RM, Abou-Al-Shaar H. Complications and visual outcomes following surgical resection of pediatric optic pathway/hypothalamic gliomas: a systematic review and meta-analysis. Child’s Nervous System. 2024;40(7):2033-2042. https://doi.org/10.1007/s00381-024-06407-7
Bezbabicheva TS, Maryashev SA, Ogurtsova AA, Eliseeva NM, Afandiev RM, Pogosbekyan EL, Pronin IN, Pitskhelauri DI. Intraoperative monitoring of cortical visual evoked potentials in resection of tumors near the optic radiation. Burdenko’s Journal of Neurosurgery. 2025;89(6):46-53. (In Russ.). https://doi.org/10.17116/neiro20258906146
Maryashev SA, Dombaanai BS, Eliseeva NM, Ogurtsova AA, Bayev AA, Pitskhelauri DI, Pronin IN. Intraoperative visual evoked potential recording in occipital tumor surgery. Burdenko’s Journal of Neurosurgery. 2023; 87(4):35-45. (In Russ.). https://doi.org/10.17116/neiro20238704135
Carrai R, Martinelli C, Baldanzi F, Gabbanini S, Gori B, Masi G, Troiano S, Bonaudo C, Esposito A, Muscas G, Tola S, Caramelli R, Spalletti M, Lolli F, Grippo A, Bucciardini L, Amadori A, Della Puppa A. Feasibility of Intraoperative Visual Evoked Potential Monitoring by Cortical Strip Electrodes in Patients During Brain Surgery: A Preliminary Study. World Neurosurgery. 2023;171:175-180.e0. https://doi.org/10.1016/j.wneu.2022.12.032

Surgical treatment of anterior visual pathway gliomas in children using intraoperative neurophysiological monitoring and MR tractography

Authors:

Николай Иванович Головин,

Сергей Кириллович Горелышев,

Анна Анатольевна Огурцова,

Рамин Малик оглы Афандиев

Журнал: Вопросы нейрохирургии имени Н.Н. Бурденко. 2026;90(5):54-60.

DOI: 10.17116/neiro20269005154

Read: 656 раз

Download PDF (EN)

Abstract

BACKGROUND

OBJECTIVE

To demonstrate two cases of surgical treatment for anterior visual pathway gliomas using preoperative MR tractography of visual pathways and intraoperative VEP monitoring.

MATERIAL AND METHODS

Two patients with anterior visual pathway tumors underwent preoperative MR tractography of visual pathways. Intraoperative VEP monitoring was performed.

RESULTS

CONCLUSION

Keywords

optic pathway glioma
MR tractography
intraoperative neurophysiological monitoring of VEP

Конфликт интересов

The authors declare no conflicts of interest.

Дата поступления: 04.06.2026

Дата принятия в печать: 20.07.2026

Дата публикации: 16.10.2026

References

Elzaafarany O, Elhomosany S, Rincones A, Dlugi V, Mokhtari S. Optic Pathway Glioma: Current Treatment Approaches and Ongoing Clinical Trials. Brain Sciences. 2025;15(8):894. https://doi.org/10.3390/brainsci15080894
Amato A, Imbimbo BP, Falsini B. Neurofibromatosis type 1-associated optic pathway gliomas: pathogenesis and emerging treatments. European Review for Medical and Pharmacological Sciences. 2023;27(12):5636-5653. https://doi.org/10.26355/eurrev_202306_32804
Chen Y, Yu J, Ge S, Jia R, Song X, Wang Y, Fan X. An Overview of Optic Pathway Glioma With Neurofibromatosis Type 1: Pathogenesis, Risk Factors, and Therapeutic Strategies. Investigative Ophthalmology & Visual Science. 2024;65(6):8. https://doi.org/10.1167/iovs.65.6.8
Kim JW, Phi JH, Kim SK, Lee JH, Park SH, Won JK, Choi JY, Kang HJ, Park CK. Comparison of the clinical features and treatment outcomes of pilocytic astrocytoma in pediatric and adult patients. Child’s Nervous System. 2023;39(3):583-591. https://doi.org/10.1007/s00381-023-05839-x
Modrzejewska M, Olejnik-Wojciechowska J, Roszyk A, Szychot E, Konczak TD, Szemitko M, Peregud-Pogorzelski JW. Optic Pathway Gliomas in Pediatric Population-Current Approach in Diagnosis and Management: Literature Review. Journal of Clinical Medicine. 2023;12(21):6709. https://doi.org/10.3390/jcm12216709
Yaman Bajin I, Bouffet E. Optic pathway and hypothalamic glioma, old problems, new paradigms. Pediatric Hematology Oncology Journal. 2023; 8(2):102-110. https://doi.org/10.1016/j.phoj.2023.04.003
Li S, Xiao W, Tong Z, Li L, Zhang Y. The Use of Diffusion Tensor Imaging in the Differentiation and Surgical Planning of Suprasellar Hypothalamic-Opticochiasmatic Glioma and Craniopharyngioma in Children. World Neurosurgery. 2024;193:474-482. https://doi.org/10.1016/j.wneu.2024.09.074
Carrozzi A, Gramegna LL, Sighinolfi G, Zoli M, Mazzatenta D, Testa C, Lodi R, Tonon C, Manners DN. Methods of diffusion MRI tractography for localization of the anterior optic pathway: A systematic review of validated methods. NeuroImage: Clinical. 2023;39:103494. https://doi.org/10.1016/j.nicl.2023.103494
Soumpasis C, Díaz-Baamonde A, Ghimire P, Baig Mirza A, Borri M, Jarosz J, Gullan R, Ashkan K, Bhangoo R, Vergani F, Lavrador JP, Mirallave Pescador A. Intraoperative Neuromonitoring of the Visual Pathway in Asleep Neuro-Oncology Surgery. Cancers. 2023;15(15):3943. https://doi.org/10.3390/cancers15153943
Guzzi G, Ricciuti RA, Della Torre A, Lo Turco E, Lavano A, Longhini F, La Torre D. Intraoperative Neurophysiological Monitoring in Neurosurgery. Journal of Clinical Medicine. 2024;13(10):2966. https://doi.org/10.3390/jcm13102966
Olmsted ZT, Silverstein JW, Einstein EH, Sowulewski J, Nelson P, Boockvar JA, D’Amico RS. Evolution of flash visual evoked potentials to monitor visual pathway integrity during tumor resection: illustrative cases and literature review. Neurosurgical Review. 2023;46(1):46. https://doi.org/10.1007/s10143-023-01955-z
Kim JW, Kim SK. The role of surgery for optic pathway gliomas in the era of precision medicine. Child’s Nervous System. 2024;40(10):3075-3083. https://doi.org/10.1007/s00381-024-06450-4
Karbe AG, Gorodezki D, Schulz M, Tietze A, Gruen A, Driever PH, Schuhmann MU, Thomale UW. Surgical options of chiasmatic hypothalamic glioma-a relevant part of therapy in an interdisciplinary approach for tumor control. Child’s Nervous System. 2024;40(10):3065-3074. https://doi.org/10.1007/s00381-024-06498-2
Bertalanffy H, Gallieni M, Mahmoodi R, Fahlbusch R, Kar S, Di Rocco C. Surgical Treatment of Optic Pathway Hypothalamic Gliomas. Advances and Technical Standards in Neurosurgery. 2025;55:17-45. https://doi.org/10.1007/978-3-031-90762-3_2
Samples DC, Mulcahy Levy JM, Hankinson TC. Neurosurgery for Optic Pathway Glioma: Optimizing Multidisciplinary Management. Frontiers in Surgery. 2022;9:884250. https://doi.org/10.3389/fsurg.2022.884250
Hill CS, Khan M, Phipps K, Green K, Hargrave D, Aquilina K. Neurosurgical experience of managing optic pathway gliomas. Child’s Nervous System. 2021;37(6):1917-1929. https://doi.org/10.1007/s00381-021-05060-8
Albalkhi I, Shafqat A, Bin-Alamer O, Mallela AN, Gersey ZC, Fernandes Cabral D, Sabbagh AJ, Hadjipanayis CG, González-Martínez JA, Friedlander RM, Abou-Al-Shaar H. Complications and visual outcomes following surgical resection of pediatric optic pathway/hypothalamic gliomas: a systematic review and meta-analysis. Child’s Nervous System. 2024;40(7):2033-2042. https://doi.org/10.1007/s00381-024-06407-7
Bezbabicheva TS, Maryashev SA, Ogurtsova AA, Eliseeva NM, Afandiev RM, Pogosbekyan EL, Pronin IN, Pitskhelauri DI. Intraoperative monitoring of cortical visual evoked potentials in resection of tumors near the optic radiation. Burdenko’s Journal of Neurosurgery. 2025;89(6):46-53. (In Russ.). https://doi.org/10.17116/neiro20258906146
Maryashev SA, Dombaanai BS, Eliseeva NM, Ogurtsova AA, Bayev AA, Pitskhelauri DI, Pronin IN. Intraoperative visual evoked potential recording in occipital tumor surgery. Burdenko’s Journal of Neurosurgery. 2023; 87(4):35-45. (In Russ.). https://doi.org/10.17116/neiro20238704135
Carrai R, Martinelli C, Baldanzi F, Gabbanini S, Gori B, Masi G, Troiano S, Bonaudo C, Esposito A, Muscas G, Tola S, Caramelli R, Spalletti M, Lolli F, Grippo A, Bucciardini L, Amadori A, Della Puppa A. Feasibility of Intraoperative Visual Evoked Potential Monitoring by Cortical Strip Electrodes in Patients During Brain Surgery: A Preliminary Study. World Neurosurgery. 2023;171:175-180.e0. https://doi.org/10.1016/j.wneu.2022.12.032

Surgical treatment of anterior visual pathway gliomas in children using intraoperative neurophysiological monitoring and MR tractography

Abstract

BACKGROUND

OBJECTIVE

MATERIAL AND METHODS

RESULTS

CONCLUSION

Keywords

Конфликт интересов

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Surgical treatment of anterior visual pathway gliomas in children using intraoperative neurophysiological monitoring and MR tractography

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