Neuro-oncology advances · 2026
Neuro-ophthalmological disturbances in pediatric posterior fossa tumors: Prevalence, risk factors, and outcomes.
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Aliotti Lippolis Maria, Koinig Sabine, Dorfer Christian, Conci Luca, Bertich Martin, Stapf Christoph, Mayr Lisa, Stepien Natalia, Hedrich Cora, Baumgartner Alicia-Christina, Schned Hannah, Köller Clara, Ahmadi Abed, Eichmüller Oliver, Haberler Christine, Slavc Irene, Czech Thomas, Rössler Karl, Kasprian Gregor, Kircher Karl, Reitner Andreas, Peyrl Andreas, Gojo Johannes, Azizi Amedeo A, Pemp Berthold
Аннотация
BACKGROUND: Neuro-ophthalmological disturbances present frequently in pediatric posterior fossa (PF) tumors, contributing significantly to morbidity. This study evaluates their prevalence, risk factors, and outcomes in affected children.
METHODS: This retrospective study analyzed 119 children with PF tumors treated over a decade at a tertiary care center, including 94 presenting at initial diagnosis and 25 at relapse. Clinical and ophthalmologic evaluations were performed preoperatively and 3 months, 1 year, and 2 years postoperatively. Prevalence of visual disturbances, central and/or peripheral oculomotor dysfunctions, optic nerve changes, and corrective ophthalmological interventions, were evaluated over time. Associations between visual/oculomotor outcomes and tumor location, histology, hydrocephalus, cerebellar mutism syndrome (CMS), and intraventricular chemotherapy were analyzed using χ2 tests.
RESULTS: At diagnosis, n = 21/94 presented due to visual symptoms, while thorough preoperative examination revealed central and peripheral oculomotor disturbances in n = 12/27 and n = 6/27, respectively. Their prevalence increased postoperatively but improved over time in one-third of patients, with earlier resolution in peripheral disturbances. Vermis/brainstem location and CMS were associated with higher rates of postoperative oculomotor disorders. Medulloblastomas exhibited an elevated risk of central disturbances. Prism correction was initially required in n = 16/94 of cases, decreasing to n = 4/64 after 2 years; strabismus surgery was performed in n = 4/64. Papilledema was common (n = 10/33) at diagnosis, and n = 8/56 developed optic atrophy during follow-up. Among patients presenting at relapse, neuro-ophthalmological disorders were frequent (central: n = 24/25; peripheral: n = 15/25), while visual acuity remained satisfactory.
CONCLUSIONS: Neuro-ophthalmological disturbances are common in pediatric PF tumors and evolve throughout treatment. Regular ophthalmologic examinations, including detailed orthoptic assessments, are essential for timely intervention.
METHODS: This retrospective study analyzed 119 children with PF tumors treated over a decade at a tertiary care center, including 94 presenting at initial diagnosis and 25 at relapse. Clinical and ophthalmologic evaluations were performed preoperatively and 3 months, 1 year, and 2 years postoperatively. Prevalence of visual disturbances, central and/or peripheral oculomotor dysfunctions, optic nerve changes, and corrective ophthalmological interventions, were evaluated over time. Associations between visual/oculomotor outcomes and tumor location, histology, hydrocephalus, cerebellar mutism syndrome (CMS), and intraventricular chemotherapy were analyzed using χ2 tests.
RESULTS: At diagnosis, n = 21/94 presented due to visual symptoms, while thorough preoperative examination revealed central and peripheral oculomotor disturbances in n = 12/27 and n = 6/27, respectively. Their prevalence increased postoperatively but improved over time in one-third of patients, with earlier resolution in peripheral disturbances. Vermis/brainstem location and CMS were associated with higher rates of postoperative oculomotor disorders. Medulloblastomas exhibited an elevated risk of central disturbances. Prism correction was initially required in n = 16/94 of cases, decreasing to n = 4/64 after 2 years; strabismus surgery was performed in n = 4/64. Papilledema was common (n = 10/33) at diagnosis, and n = 8/56 developed optic atrophy during follow-up. Among patients presenting at relapse, neuro-ophthalmological disorders were frequent (central: n = 24/25; peripheral: n = 15/25), while visual acuity remained satisfactory.
CONCLUSIONS: Neuro-ophthalmological disturbances are common in pediatric PF tumors and evolve throughout treatment. Regular ophthalmologic examinations, including detailed orthoptic assessments, are essential for timely intervention.