optic glioma

שלום דוקטור ביתי בת 12 ואובחנה כבעלת optic glioma מגיל 9.הגידול שפיר ויושב על צומת עצב הראיה ומשפיע על הראיה בשתי העיניים. כיום היא אינה רואה כלל בעין ימין וראייתה בעין שמאל התדרדרה. לאחר כ 10 טיפולים כימוטרפיים מצבה לא השתפר. אני מתלבט לגבי המשך הטיפול הכימי. האם כדאי לעבור להקרנות? מה רמת הסיכון בטיפול זה ואולי כדאי לנסות ניתוח להסרת הגידול? מצ"ב האבחנה המקצועית של ביתי: “The child, a 12-years o1d girl was born after a normal pregnancy and delivery and without skin spots. There is no neurofibromatosis in the family. At age 8 month a right eye squint was observed. She was treated by occlusion of the left eye and was under supervision in the Pediatric Ophthalmology' out-Patient Clinic of another hospital, From 1990 until 1997 the visual acuity of the right "amblyopic”, eye was fairly constant at 6/10-6/12, with 6/6 in the left eye. In March 1997 the visual acuity of the right eye was 6/10 but five months later, in July 1997 decreased to 6/60. CT scan and MRI, performed for the first time, disclosed the presence of a glioma of 'the right optic nerve and optic chiasm. When she was referred to our Unit of Neuro-Ophthalmology in August 1997, the visual acuity was c.f. 40 cm for the right eye and, for the left eye, 6/6, as before. There was a right afferent pupil defect and temporal pallor of the right disk with loss of the nerve fiber layer. Goldmann perimetry with V/4 isopters showed the presence of a large, thick caecocentral scotoma in the right eye. The 'field of 'the left eye was normal with I/4, I/3, I/2 isopters and there was a normal-size blind spot. There was statokinetic dissociation and on static perimetry (Humphrey 30/2). There were points of the lowering of sensitivity on the temporal field of the left eye. The contrast sensitivity curve Of the right eye was normal. The optic nerves in the coronary cut in mid-orbit appeared of normal size but in the cuts towards the posterior part the right optic canal was seen to be enlarged and there was a large tumor process also penetrating the optic chiasm. During follow-up from August to December the visual acuity of the right eye has remained c.f. 40 cm and that of the left eye is 6/6. The VEP of the left eye was normal but there is a lowering of the contrast sensitivity curve in the high-frequency cycle side, an enlargement of the blind spot in the kinetic field of the; left eye, and a worsening of the temporal field on static perimetry of the 1eft eye. It should be noted that during the, past week the child had a left eye black-eye attack. We believe that immediate X-ray therapy is indicated the management of this case.”

שלום גיורא צר לי לשמוע על ביתך, אני כירורג כללי ואת שאלתך יש להפנות לרופא עיניים או נוירוכירורג. נכון לומר באופן כללי כי אם טיפול כימי אינו משפיע יש לפנות לאמצעים כמו קרינה וכירורגיה עם ידיעת המגבלות והסיבוכים. מקווה שתצליחו דר' ויזר