Tumours, masses and neoplasia
Optic nerve glioma
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Low-grade astrocytic tumour (technically also a hamartoma)
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Juvenile (good prognosis) and adult (poor prognosis) forms
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50% affect the orbital portion of the nerve, causing
- Proptosis: axial
- Optic disc swelling
- Strabismus
- Visual loss
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50% do not grow but the remainder do and need excision
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Associated with NF-1 (30-50% of patients)
Hot Topic
Neuroimaging in optic nerve glioma
- Reveals a fusiform enlargement of the nerve perhaps with kinking within the orbit
Histology
- Features of pilocytic astrocytomas, Rosenthal fibres (enlarged deeply eosinophilic filaments)
Prognosis
- Often good but vision may be lost
Treatment
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For severe proptosis with exposure/cosmesis, intracranial extension or (threatened) chiasmal involvement
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Surgical excision
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Radiotherapy
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Chemotherapy