1. Non-Syndromic Optic Chiasm Mass in an Adult
Gaurav Gupta, M.Sc.
Stanford University School of Medicine
MGH Neurosurgery Subinternship
September 23, 2010

2. Case Presentation ID: 42 yo M with optic chiasm mass
HPI: 40 lb weight loss over 6 months; loss of libido, fatigue, polydipsia/polyuria X 4 months; blurred vision X 6 weeks
No significant PMH, no medications, FH/SH noncontributory
No history of radiation
MRI 2005: “partially empty sella”, no other abnormalities
Exam: Dense bitemporal hemianopsia

4. Work-up and Differential Diagnosis
Primary glial neoplasm
Germ cell tumor
Primary CNS lymphoma
Metastasis of unknown primary
Isolated inflammatory process (e.g. neurosarcoidosis)

5. NF1: Age at Diagnosis
Dermatology. 2008;216(4):347-8.

7. J Clin Neurosci. 2007 May;14(5):502-5.

8. Germ Cell Tumor
J Neurooncol Dec;95(3):

9. Surgical Approaches Minimally invasive Open
Extended endoscopic endonasal
Endoscopic transventricular
Open
Pterional
Transorbital/subfrontal
Subfrontal

10. Extended Endoscopic Endonasal
Adv Tech Stand Neurosurg. 2008;33:151-99

12. Endoscopic Transventricular
ETV
J Neurosurg Aug 13.

13. Craniotomy for Optic Chiasm Malignancy
Medlock and Scott. Pediatr Neurosurg Sep;27(3):

14. Gross Appearance at Biopsy

15. Pathology
In initial stain of tissue samples, < 50% of cells took up GFAP, CD45, p53, Ki-67, IDH-1, and CD68
These will be re-stained along with PLAP (placental alkaline phosphatase), Oct4, c-kit/CD117

16. Emerging Diagnostic Modalities
PET-CT co-registered with MR spectroscopy
Increase in SUV and choline/creatine ratio distinguish high-grade from low-grade optic glioma in NF1 patients (Clin Nucl Med Oct;35(10):838-9.)
3.0T DTI
Optic gliomas may be detected by decreases in fractional anisotropy (J Magn Reson Imaging Jul;32(1):76-81.)
Dynamic contrast-enhanced (DCE) MRI
Clinically aggressive optic gliomas have significantly higher mean permeability values (Pediatr Radiol :1293–1299)

17. Questions