LGG-15. Risk to Visual Acuity after Surgical Intervention in Pediatric Optic Pathway Glioma

Abstract Introduction Optic pathway gliomas (OPG) are challenging neoplasms requiring long-term multidisciplinary care. Given a primary treatment goal of visual preservation, surgical intervention should be carefully considered and applied only for select indications. We sought to review the impact to vision after surgical intervention relative to other treatment modalities or conservative management. Methods 90 pediatric optic pathway glioma patients (21 years) at Boston Children’s Hospital from January 1994 to April 2024 were reviewed. Demographic, histopathologic, molecular, and clinical information was collected. Visual acuity was broken into three grades (I: = 20/30, II: 20/30 - 20/100, III: =20/100) to facilitate analysis. Statistical analysis was conducted using Kaplan-Meier estimator, Fisher’s exact test, and McNemar’s test (p 0.05). Results 31 patients received surgery, 65 patients underwent chemotherapy, and 3 patients received radiation therapy. 21 patients received no treatment. Patients who underwent surgery had inferior visual acuity on initial evaluation (OD:I-33.3%, II-8.5%, III-48.2%, OS:I-39.3%, II-17.9%, III-42.9%) as compared to those who were treated with chemotherapy alone (OD:I-17.7%, II-44.1%, III-38.2%, OS:I-26.5%, II-38.2%, III-35.3%) or received no treatment (OD:I-40%, II-55%, III-5%, OS:I-45%, II-45%, III-10%). Visual acuity after surgical treatment was not substantially worse, and was in some cases improved (OD:I-41.9%, II-6.5%, III-51.6%, OS:I-35.5%, II-19.4%, III-45.2%). These results were similar to those seen for patients who underwent chemotherapy alone (OD:I-30.6%, II-33.3%, III-36.1%, OS:I-41.7%, II-13.9%, III-44.4%). Overall survival (OS) at 5 years was 98.6% (90.7-99.8%) and 10 years was 90.7% (76.2-96.5%). Conclusion Patients who underwent surgical intervention for OPG presented with significantly worse vision on initial evaluation than those who did not receive any treatment, and mildly worse vision compared to those who underwent treatment with chemotherapy alone. With appropriate patient selection and application, visual outcomes after surgery for pediatric OPG are relatively similar to those after treatment with chemotherapy alone.