Optic Nerve Glioma's

Coronal noncontrast T1-weighted MRI reveals a large intraorbital mass (arrow) centered on the optic nerve.

Coronal postgadolinium T1-weighted MRI with fat saturation (same patient as in Image above) reveals diffuse, intense enhancement of the intraorbital mass (arrow).


Axial postgadolinium T1-weighted MRI with fat saturation (same patient as in Images above) reveals diffuse, intense enhancement of the intraorbital mass. The lesion is confined to the orbit.

Optic nerve glioma's are the most common primary neoplasm of the optic nerve. They are found in or around the nerves that send messages from the eyes to the brain. A low-grade form of this neoplalm occurs most often in pediatric patients and presents itself as a benign tumor. Optic nerve and optic chiasmal gliomas are slow-growing and the tumor sometimes produces additional symptoms as it grows. In most young patients the presenting symptom is painless proptosis. Also other symptoms include optic atrophy, reduced visual acuity and large lesions may compress the optic chiasm causing nystagmus, or the glioma may also compress the third ventricle resulting in obstructive hydrocephalus accompanied by headache, nausea, and vomiting. Hypothalamic syptoms such as changes in appetitie or sleep may also occur. The benign glioma is usually very slow growing, if at all, over extended periods. However some lesions can progress causing visual impairment, so ongoing follow up is recommended.

Twenty percent of optic gliomas that extend to the optic chiasm or beyond into the optic radiations, demonstrate a more agressive course. Aggressive glioma is most common in adults and it is frequently fatal even with treatment. Despite aggressive radiation, chemotherapeutic, or surgical treatment, aggressive glioma is an almost uniformly fatal disease.

MRI is the prefered method of evaluation of the optic nerve glioma. Both the intraorbital lesion and its intracranial extent can be effectively characterized through MRI. Gadolinium enhanced T1-weighted images with the fat saturation can define the extent of the aggressive glioma.