To image or not to image.

An 8-year-old girl was first seen at the age of 4 with nystagmus and hypoplastic discs. Subsequent follow-up demonstrated poor visual acuity and optic atrophy. A CT scan showed a chiasmal or perichiasmal mass. The presumptive diagnosis of an optic chiasmal glioma is being considered. The use of neuroimaging in chiasmal or perichiasmal lesions and the natural history and treatment of optic nerve and chiasmal gliomas are discussed.