Kotecha Megha, Gotecha Sarang, Chugh Ashish, Punia Prashant
Department of Ophthalmology, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.
Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.
Case Rep Ophthalmol Med. 2021 May 15;2021:7793382. doi: 10.1155/2021/7793382. eCollection 2021.
All children between 0 and 16 years presenting with brain tumours confirmed by Magnetic Resonance Imaging (MRI) and treated surgically in our institute were included in this study.
The aim of this study is to evaluate the neuroophthalmic and clinical characteristics of intracranial space occupying lesions in children.
Neuroophthalmic manifestations along with location of the tumour by contrast-enhanced MRI, type of surgical intervention, and postoperative histopathological diagnosis were evaluated.
In pediatric brain tumours, male preponderance was seen and supratentorial location was more common in general, while in older children, infratentorial tumours were more common than supratentorial tumours. Headache, vomiting, and cerebellar signs were the commonest neurological features. Diminution of vision, diplopia, and strabismus were the commonest ophthalmic symptoms. Papilledema, ophthalmoparesis, and nystagmus were the most frequent ophthalmological signs. Neurological manifestations of seizures, altered sensorium and motor deficits were more frequently seen in supratentorial tumours, while cranial nerve involvement and ataxia were seen in infratentorial tumours. Ophthalmological manifestations including diplopia, strabismus, ophthalmoparesis, and nystagmus were more frequently seen in infratentorial tumours. Astrocytoma was the most frequent histopathological diagnosis followed by medulloblastoma.
Diagnosis of pediatric intracranial tumours is complex and requires a multidisciplinary approach for prompt management. An ophthalmologist should have a high index of suspicion for brain tumours especially in patients presenting with common ocular symptoms like diminution of vision, diplopia, and strabismus without any neurological symptoms.
本研究纳入了所有0至16岁经磁共振成像（MRI）确诊为脑肿瘤并在我院接受手术治疗的儿童。
本研究旨在评估儿童颅内占位性病变的神经眼科和临床特征。
评估神经眼科表现、增强MRI显示的肿瘤位置、手术干预类型及术后组织病理学诊断。
在儿童脑肿瘤中，总体上男性居多，幕上位置更为常见，而在年龄较大的儿童中，幕下肿瘤比幕上肿瘤更常见。头痛、呕吐和小脑体征是最常见的神经学特征。视力减退、复视和斜视是最常见的眼科症状。视乳头水肿、眼球运动麻痹和眼球震颤是最常见的眼科体征。癫痫发作、意识改变和运动功能障碍等神经学表现更多见于幕上肿瘤，而幕下肿瘤则可见脑神经受累和共济失调。包括复视、斜视、眼球运动麻痹和眼球震颤在内的眼科表现更多见于幕下肿瘤。星形细胞瘤是最常见的组织病理学诊断，其次是髓母细胞瘤。
儿童颅内肿瘤的诊断较为复杂，需要多学科方法进行及时管理。眼科医生应对脑肿瘤保持高度怀疑，尤其是对于那些出现视力减退、复视和斜视等常见眼部症状而无任何神经学症状的患者。
