The management of pediatric hypothalamic/chiasmatic gliomas is currently a controversial issue within the fields of pediatric neurosurgery, neuro-oncology, and radiation oncology. These discrepancies have provided the fuel for a retrospective study I am currently performing in an attempt to link treatment modalities and long-term outcome. The common thread driving the inconsistencies in care is that the natural history of pediatric hypothalamic/chiasmatic gliomas is erratic and difficult to predict. The literature shows a wide range of outcomes ranging from rapid progression of disease to indolence over years and in some instances spontaneous regression. A 1995 paper describes the standard approach to treatment employed from 1975 to 1991: biopsy for histologic diagnosis; if low-grade, then limited resection followed by chemotherapy for young children and radiation in older children. Recurrences were treated with either chemotherapy or radiation depending on which modality had not been used previously. In the event that both modalities failed, then radical resection was undertaken.

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