Determinants of long-term visual outcomes after tumor debulking in children with sporadic optic pathway glioma.
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OBJECTIVE: The surgical management of sporadic optic pathway glioma (OPG) remains controversial due to its unpredictable visual outcomes and uncertain risk-benefit balance. This study aimed to identify key clinical and surgical determinants of long-term visual preservation following tumor debulking in children with sporadic OPG. METHODS: A total of 192 pediatric patients who underwent initial partial resection for sporadic OPG at Beijing Tiantan Hospital between 2011 and 2023 were retrospectively analyzed. Two complementary outcomes were assessed: follow-up visual acuity (VA) of the better-eye defined at baseline and individual visual change. Ordinal and binary logistic regression analyses were performed to identify predictors, supplemented by trend and visualization analyses. RESULTS: Baseline VA was the strongest predictor of follow-up VA of the baseline-defined better-eye (OR = 5.88, P < 0.001). Poorer outcomes were associated with younger age (< 3 years), delayed surgery, extent of resection ≥ 50%, and postoperative radiotherapy. Among patients with moderate baseline VA, a greater resection extent showed a trend toward worse outcomes. The anterior interhemispheric approach was linked to higher risk of visual deterioration, whereas transcallosal and frontotemporal approaches were protective. Early intervention, limited resection, and careful avoidance of high-risk surgical corridors were associated with better long-term visual preservation. CONCLUSIONS: Preoperative baseline VA determines postoperative visual potential, while surgical timing, extent, and approach critically shape long-term outcomes. Patients with moderate baseline VA are the most intervention-sensitive subgroup. These findings support early, conservative, and function-oriented surgical strategies to optimize visual outcomes in pediatric sporadic OPG.