Spontaneous intraventricular hemorrhage from low-grade optic glioma: case report and review of the literature

Glioma del nervio óptico en paciente adulto con presentación hemorrágica tratado mediante abordaje endoscópico transesfenoidal extendido

Introducción:

El glioma del nervio óptico es una entidad de muy baja incidencia en pacientes adultos, lo cual impide tener suficiente información sobre historia natural y conducta terapéutica en este grupo etario.

Presentación del Caso:

En el presente artículo comunicamos el caso de un paciente de 27 años de edad con compromiso agudo del nervio óptico izquierdo debido a hemorragia intra tumoral, forma de presentación muy poco común en este tipo de tumores. Se realizó la resección mediante un abordaje endoscópico transesfenoidal extendido, con preservación funcional de la vía óptica contralateral. La anatomía patológica confirmó astrocitoma pilocítico positivo para el rearreglo KIAA 1549-BRAF. y negativo para la mutación BRAF V600E. Teniendo en cuenta la histopatología y biología molecular en este caso, la estabilidad visual contralateral y la resección quirúrgica amplia, se decidió no realizar tratamiento adyuvante con radioterapia o quimioterapia. El objetivo de esta conducta fue evitar lesiones adicionales sobre el quiasma, nervio óptico contralateral y/o hipotálamo.

Conclusión:

Dada la escasa información existente en la literatura médica, el reporte de este caso podría contribuir con información adicional en el manejo y conducta terapéutica de este tipo de lesiones.

Optic pathway-hypothalamic glioma hemorrhage: a series of 9 patients and review of the literature

OBJECTIVEHemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases.METHODSA total of 34 patients were analyzed. Nine new cases were collected, and 25 were identified in the literature. Data regarding demographics, radiological and histological features, treatment, and outcome were retrospectively reviewed.RESULTSThe majority of patients were younger than 20 years. Only 3 patients were known to have neurofibromatosis. The histopathological diagnosis was pilocytic astrocytoma in the majority of cases. Five patients had intraorbital hemorrhages, whereas 29 patients had intracranial hemorrhage; the majority of intracranial bleeds were treated surgically. Six patients, all with intracranial hemorrhage, died due to recurrent bleeding, hydrocephalus, or surgical complications. No clear risk factors could be identified.CONCLUSIONSIntracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.

Repeat Bleeding 18 Years After Hemorrhagic Pilocytic Astrocytoma: Prognostic Implications of Conservative Management-Case Report and Literature Review

BACKGROUND

Acute hemorrhagic occurrence of pilocytic astrocytomas is extremely rare but has become increasingly recognized and often presents in clinically emergent situations. The precise significance of hemorrhage in these tumors and its pathogenetic mechanisms have not yet been defined. Nothing is known about the natural history of bleeding pilocytic astrocytomas.

CASE DESCRIPTION

A 21-year-old man presented with acute biventricular hydrocephalus for repeat bleeding of a midbrain lesion that had been diagnosed 18 years earlier after a similar acute hemorrhagic episode. The patient had been initially treated conservatively, considering the high risk of surgery. He underwent urgent biventricular external shunt surgery and, subsequently, total removal of the lesion. Histopathological analysis revealed pilocytic astrocytoma. Including the present case, 59 cases were analyzed and reviewed, including 5 cases with a pilomyxoid variant. Different pathogenetic mechanisms have been proposed, including histological characteristics, rupture of the bridging veins torn by the neoplastic mass, and vascular instability determined by overexpression of vascular endothelial growth factor.

CONCLUSIONS

To the best of our knowledge, the presented case is completely unique owing to the long-term observational follow-up data available. The hemorrhagic potential did not decrease over time, representing a specific feature of this tumor. The occurrence of bleeding might not reflect either malignancy or aggressiveness. However, the worse prognosis is related to the clinical behavior, with life-threatening complications often associated. Surgery remains the standard treatment and will influence the final prognosis.

[Chiasm and optic nerve glioma manifested as hemorrhage (two clinical cases and a literature review)]

The article presents two rare clinical cases of low-grade (WHO grade I-II) glioma of the anterior visual pathway structures, the chiasm and optic nerves, in adults. The feature of these cases was the benign nature of a chiasm and optic nerve glioma in adults as well as its presentation in the form of hemorrhage to the tumor and parenchymal and subarachnoid space, which to some extent complicated making the correct diagnosis. Removal of an intracerebral hematoma and open tumor biopsy were performed in one case, and removal of a hematoma and partial tumor resection followed by radiotherapy were performed in the other case.

Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity

BACKGROUND

Hemorrhage as a presenting feature in pilocytic astrocytoma is an extremely rare phenomenon. When seen in children, most of such tumors exist in the cerebellum. Rarely, a supratentorial pilocytic astrocytoma can present with bleeding.

RESULTS

We present similar two cases and discuss the pathophysiology of such hemorrhage and histopathological changes in thinned hyalinised vessels of this tumor.

CONCLUSION

The presence of calcifications in the peri-hemorrhagic areas and the presence of mass effect disproportionate to the size of the bleeding are harbingers of the presence of a benign neoplasm that may have bled.