The involvement of important structures precludes a complete surgical resection, with the exception of optic-nerve gliomas restricted to the optic nerve. Unless proptosis is severe, a single optic-nerve glioma can be observed until there is evidence of extension posteriorly or loss of vision. Then, the optic-nerve glioma can be excised completely. In general, the tumor cannot be removed without jeopardizing visual function. Posteriorly located optic-pathway gliomas can be debulked to relieve mass effect, or if relief of hydrocephalus is needed. For any of these procedures, great care must be taken to avoid injury to the hypothalamus and to protect existing vision. Adjunctive therapy is often used to stabilize tumor growth. In older children, external-beam radiation therapy is the mainstay of treatment, although newer chemotherapy protocols have been used in both younger and older children.
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