What question did this study set out to answer?

The aim is to evaluate the outcomes of surgical management for optic pathway-hypothalamic gliomas based on institutional experience and existing literature.

February 20, 2026

Surgical Management of Optic Pathway-Hypothalamic Gliomas: Institutional Experience and Systematic Review

Key Points

The aim is to evaluate the outcomes of surgical management for optic pathway-hypothalamic gliomas based on institutional experience and existing literature.
Retrospective review of patients with OPHGs who underwent surgery at the institution.
Systematic review of literature for surgically treated OPHG cases.
Analysis of clinical presentation, surgical approach, extent of resection, complications, and outcomes.
In the institutional cohort, 33% had gross total resection and complications included 11% with diabetes insipidus.
Visual disturbance was the most common symptom, noted in 56% of institutional patients.
Tumor recurrence was observed in 33% of cases at an average of 27.3 months post-surgery.

Abstract

BACKGROUND AND OBJECTIVES: Because of the proximity of optic pathway-hypothalamic gliomas (OPHGs) to critical neuroanatomical structures and their unpredictable natural history, the role of resection in their treatment is often debated. We present our institutional surgical experience and a systematic review of outcomes in patients with surgically treated OPHG. METHODS: The health records of patients with OPHGs who underwent surgery at our institution were retrospectively reviewed. A systematic review of the literature was also performed to extract surgically treated OPHG cases. Clinical presentation, surgical approach, extent of resection, complications, and outcomes were analyzed. RESULTS: A total of 9 adult patients from our institution were included (mean age 32.3 ± 17.3 years; 5 women 56%), and we identified 15 studies that met inclusion criteria with a total of 50 patients (mean age 14.4 ± 11.2 years; 24 women 48%). Visual disturbance was the most common presenting symptom (56% of our patients and 76% of patients from the literature). The most common pathology was pilocytic astrocytoma (67% in our cohort, 62% of patients in the literature). In our cohort, tumors involved the hypothalamus (67%), optic chiasm (67%), and optic nerve (56%), and 33% of patients had gross total resection. In the historical cases, tumors involved the hypothalamus (94%), optic chiasm (42%), and optic nerve (16%), and 12% of patients had gross total resection. Complications in our series included diabetes insipidus (11%), anterior choroidal infarct (11%), and ptosis (11%), and in the literature, new endocrine dysfunction (28%) and visual disturbance (16%) were reported. Three patients (33%) had tumor recurrence at a mean of 27.3 ± 7.6 months, whereas 11 patients (22%) reported in the literature had tumor recurrence at a mean of 55.7 ± 44.3 months. CONCLUSION: Surgery can be performed with reasonable risk and can play a key role in the multidisciplinary management of select patients with OPHG.

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