Improvement of visual acuity caused by opticochiasmal astrocytoma after treatment for associated hydrocephalus - Case report

Abstract

A 33-year-old male presented with syncopal attacks. He had a history of slowly progressive deterioration of visual acuity in both eyes. His visual deterioration began in the left eye at age 12 years and in the right eye at age 20 years. His left eye was completely blind by age 33 years. He had received no prior treatment for these visual disturbances. Magnetic resonance (MR) imaging on admission showed a large tumor with inhomogeneous intensity occupying the bilateral optic canals and orbital cavities, with extension to parasellar region. Arachnoid cysts were found in the left middle fossa and supracerebellar space, which had caused herniation of the cerebellar tonsils to the foramen magnum. Open biopsy and histology verified that the tumor was pilocytic astrocytoma. Arachnoid cysts associated with the hydrocephalus were treated with a ventriculoperitoneal shunt. Seven years after surgery, visual acuity of the right eye had improved although the left eye remained blind. Follow-up MR imaging demonstrated marked reduction in size of the ventricles and arachnoid cysts, but the tumor size did not change. This case illustrates the benign nature of low-grade glioma in this region in spite of the large size and long history. Deterioration of visual acuity may be reversible in some cases of opticochiasmal astrocytoma. In our case, the improvement in visual acuity probably resulted from growth arrest of the tumor and improvement in the dynamics of cerebrospinal fluid flow.