Surgical treatment of chiasmal glioma in neurofibromatosis 1.

A 3-year-old boy with neurofibromatosis 1 had 20/40 acuity OU with normal color vision, confrontation visual fields, and optic nerves. MRI showed a large mass in the suprasellar cistern with superior and anterior displacement of the chiasm (figure, A and B). He underwent transcallosal surgical resection of the tumor, with pathology demonstrating low-grade glioma. Six months later, visual acuity was 20/25 OU, with normal color vision and confrontation fields. MRI showed restoration of normal suprasellar anatomy (figure, C and D). Surgical resection can restore vision when an optic pathway glioma extends downward into the suprasellar cistern to extrinsically compress the chiasm.1,2