Conservative treatment of paediatric hypothalamic and optic pathway gliomas

Low-grade glioma is the most common form of childhood brain tumour, comprising nearly 40% of all primary central nervous system tumours diagnosed in patients under 18 years of age. The role of surgery is limited with no affect on overall survival and its goal is to avoid shunt replacement in the case of obstructive hydrocephalus and to postpone radiation. Present recommendations are that patients less than 8 years of age be treated with chemotherapy as first line treatment, avoiding long-term cognitive and neuroendocrine sequelae seen with surgery and radiation therapy. A variety of different drug regimens have shown efficacy in patients with both newly diagnosed, progressive disease and those with recurrent lesions.