Neuro-ophthalmological disturbances in pediatric posterior fossa tumors: Prevalence, risk factors, and outcomes

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 three months, one-year and two-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 two 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.