Neuro-ophthalmological disturbances in pediatric posterior fossa tumors: Prevalence, risk factors, and outcomes.
In a single-center retrospective cohort of 119 children with posterior fossa tumors, neuro-ophthalmological abnormalities were frequent at diagnosis, after surgery, and at relapse, with postoperative oculomotor disorders associated with vermis/brainstem location, medulloblastoma, and cerebellar mutism syndrome.
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In a single-center retrospective cohort of 119 children with posterior fossa tumors, neuro-ophthalmological abnormalities were frequent at diagnosis, after surgery, and at relapse, with postoperative oculomotor disorders associated with vermis/brainstem location, medulloblastoma, and cerebellar mutism syndrome.
Research significance
The study provides observational evidence that serial ophthalmologic and orthoptic assessment identifies clinically relevant, evolving deficits; it is reasonable—but not tested here—to hypothesize that risk-adapted surveillance and timely prism or surgical correction could reduce long-term visual and functional morbidity.
Source abstract
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.