Visual Complications of Pediatric Posterior Fossa Tumors: Analysis of Outcomes

Gadgil, Nisha; Edmond, Jane C.; Stormes, Katie; Lam, Sandi; Shah, Veeral S.

doi:10.1016/j.pediatrneurol.2018.09.016

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…We found that pediatric patients with primary brain neoplasms not intrinsic to the anterior visual pathways had significant ophthalmologic morbidity associated with their underlying disease. Indeed, 44 (57%) patients met our criteria for being visually impaired, compared with 10.6% in a study of patients with posterior fossa tumors and 66% among patients with craniopharyngiomas [ 12 , 13 ]. Seven (9%) patients met criteria for legal blindness, which is similar to the rate found for craniopharyngiomas (10%) [ 13 ].…”

Section: Discussionmentioning

confidence: 78%

“…Seven (9%) patients met criteria for legal blindness, which is similar to the rate found for craniopharyngiomas (10%) [ 13 ]. In patients with posterior fossa brain tumors, the rate of VA meeting criteria for legal blindness ranged from 0–7.4%, (although the 7.4% number includes 3/9 total patients with “good” VA in one eye) [ 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Vision-related quality-of-life in pediatric primary brain tumor patients

et al. 2021

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Purpose: Brain tumors are the leading cause of death from childhood cancer. Although overall survival has improved due to earlier detection, better therapies, and improved surveillance, visual dysfunction and impaired vision-related quality-of-life (VR-QOL) are often unrecognized in children. This project investigated VR-QOL in pediatric brain tumor patients. Methods: We evaluated visual impairment and quality-of-life (QOL) in a quality improvement project at one tertiary care center. Patients ≤18, greater than 6 months from diagnosis of brain tumor, excluding intrinsic anterior visual pathway tumors, underwent standardized neuro-ophthalmologic examination. Health-related QOL (HR-QOL) [PedsQL Brain Tumor Module] and VR-QOL questionnaires [CVFQ (Children’s Visual Function Questionnaire) in children ˂8, and EYE-Q in children 8–18] were obtained from patients and parents. Results: Among 77 patients, craniopharyngiomas (n=16, 21%) and astrocytomas (n=15, 20%) were the most common tumors. Among 44/77 (57%) visually impaired children, 7 (16%) were legally blind. Eye-Q median score was 3.40 (interquartile range 3.00–3.75), worse than average scores for normal children. Eye-Q score decreased 0.12 with every 0.1 increase in logMAR visual acuity [p<0.001]. Patients who were legally blind had a significantly lower Eye-Q score than those who were not (0.70 vs. 3.44 [p<0.001]). Cognitive HR-QOL scores decreased 1.3 for every 0.1 increase in logMAR visual acuity [p=0.02]. Conclusions: Pediatric brain tumor patients’ vision, HR-QOL, and VR-QOL were often severely affected even when tumors were considered cured. Visual acuity and legal blindness correlated with VR-QOL. Systematic neuro-ophthalmologic examinations in pediatric primary brain tumor patients are necessary to facilitate early preventative and corrective ophthalmologic interventions.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Vision-related quality-of-life in pediatric primary brain tumor patients

et al. 2021

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“…Previous studies have analyzed the prevalence of abnormal ophthalmological findings in children with a primary brain tumor. However, most of these studies included only children with a certain type of brain tumor (20,32–35), or children examined regarding a specific type of abnormal ophthalmological finding (22,35,36). Moreover, some studies did not primarily assess the visual function at the time of diagnosis of a brain tumor (7,21,22,36), which makes it challenging to meaningfully compare the prevalence of abnormal ophthalmological findings of the present study with previously published studies.…”

Section: Discussionmentioning

confidence: 99%

Ophthalmological Evaluation in Children Presenting With a Primary Brain Tumor

Nuijts

Stegeman²,

Porro³

et al. 2021

Journal of Neuro-Ophthalmology

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Background: Children with a brain tumor are prone to develop visual impairment, which to date is often underestimated and unrecognized. Our aim was to assess the prevalence of ophthalmological evaluation and abnormal ophthalmological findings, and investigate whether demographic and tumor-related characteristics are associated with abnormal ophthalmological findings in children presenting with a primary brain tumor. Methods: Medical records of all 90 children diagnosed with a primary brain tumor between June 2018 and May 2019 and treated at the Princess Máxima Center for Pediatric Oncology, a tertiary referral center in the Netherlands, were retrospectively reviewed. Univariate regression analysis was used to investigate associations between demographic, tumor-related and clinical characteristics, and abnormal ophthalmological findings. Results: Sixty children (34 male [56.7%]; median [range] age, 9.3 [0–16.9] years) underwent ophthalmological evaluation within 6 weeks before or after diagnosis, 11 children (5 male [45.5%]; median [range] age, 5.7 [0.1–17.2] years) were seen more than 6 weeks before or after diagnosis, and 19 children (7 male [36.8%]; median [range] age, 7.2 [1.9–16.6] years) did not receive ophthalmological evaluation within at least 6 months from diagnosis. A total of 19 children (21.1%) presented with visual symptoms as first sign leading to the diagnosis of a brain tumor. Children who presented with visual symptoms (odds ratio [OR], 22.52; 95% confidence interval [CI], 4.90–103.60) and/or hydrocephalus (OR, 3.60; 95% CI, 1.38–9.36) at diagnosis were more often seen for ophthalmological evaluation. The most common abnormal ophthalmological findings were eye movement disorders (66.0%), papilledema (44.1%), and visual field defects (58.1%). Eye movement disorders occurred more frequently in patients with an infratentorial tumor (OR, 4.71; 95% CI, 1.03–21.65). The risk of papilledema was associated with older age (OR, 1.19; 95% CI, 1.05–1.34), hydrocephalus (OR, 9.63; 95% CI, 2.68–34.61), and infratentorial (OR, 9.11; 95% CI, 1.77–46.78) and supratentorial (OR, 13.13; 95% CI, 1.92–89.52) tumors. Conclusions: In this study, most children with a primary brain tumor underwent ophthalmological evaluation around diagnosis, 21% of the children were not evaluated. The high prevalence of abnormal ophthalmological findings stresses the importance of early standardized ophthalmological evaluation to detect visual impairment and provide timely treatment to potentially prevent permanent visual loss.

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“…One study 5 at 2 large tertiary referral centers of 139 patients with posterior fossa tumors found symptoms in less than 50% of the cohort and reported that tumors with more aggressive growth patterns had significantly worse visual outcomes, including 17% with visual acuity less than or equal to 20/40. Another study 6 of 182 patients with posterior fossa neoplasms found only 27% with ophthalmologic symptoms, and while esotropia was more common (29%), visual acuity was less than or equal to 20/40 in 10% of patients.…”

Section: Introductionmentioning

confidence: 96%

Referral for Ophthalmology Evaluation and Visual Sequelae in Children With Primary Brain Tumors

et al. 2019

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Key Points Question In children with brain tumors, what is the referral rate to ophthalmology and what is the prevalence of visual sequelae and their association with tumor characteristics? Findings In this cohort study of 141 children with primary brain tumors, only 68 (48%) were referred for comprehensive eye examination. While only 15% of those referred had visual symptoms, more than 90% had a variety of visual impairments including both afferent and efferent diseases, with visual field defects being the most common impairment among patients without symptoms. Meaning Ophthalmologic evaluation is recommended for early diagnosis of visual sequelae in children with brain tumors to prevent permanent vision loss.

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Visual Complications of Pediatric Posterior Fossa Tumors: Analysis of Outcomes

Cited by 8 publications

References 14 publications

Vision-related quality-of-life in pediatric primary brain tumor patients

Vision-related quality-of-life in pediatric primary brain tumor patients

Ophthalmological Evaluation in Children Presenting With a Primary Brain Tumor

Referral for Ophthalmology Evaluation and Visual Sequelae in Children With Primary Brain Tumors

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