Occipital lobe glial and glioneuronal tumors: A systematic review of clinical presentation, surgical management, and outcomes
Ali K. Al-Shalchy, Nooruldeen H. Al-Khafaji, Rania H. Al-TaieBackground:
Glial and glioneuronal tumors in the occipital lobe are uncommon lesions that have unique clinical and surgical considerations because of their connection to the visual cortex, optic radiations, and posterior associative networks. Information on these tumors is scattered across case reports, small series, and limited retrospective studies.
Methods:
A systematic review was conducted to identify studies reporting primary occipital lobe tumors such as glial, ependymal, or glioneuronal types. Eligible tumors included diffuse gliomas, glioblastoma, astrocytoma, oligodendroglioma, pilocytic astrocytoma, pleomorphic xanthoastrocytoma, astroblastoma, ependymoma, ganglioglioma, dysembryoplastic neuroepithelial tumor, papillary glioneuronal tumor, and subependymal giant cell astrocytoma (SEGA)/SEGA-like tumors. Data were summarized descriptively, using crude proportions. The denominators varied based on the outcome and included only patients with available data.
Results:
A total of 25 studies, including 334 patients, were analyzed. Men represented 169 out of 287 cases (58.9%). The most common symptom was visual disturbance, seen in 23 of 36 patients (63.9%), followed by seizures in 13 of 28 (46.4%), headaches in 7 of 20 (35.0%), and focal neurological deficits in 6 of 27 (22.2%). Tumors on the right side were slightly more prevalent than those on the left (154/288, 53.5% vs. 132/288, 45.8%). High-grade tumors, primarily glioblastoma/grade 4 diffuse glioma, made up 96.1% of cases (320/333), mainly driven by the World Health Organization grade 3–4 lesions. Surgery was performed on 301 patients (90.4%), with gross-total resection in 165 (49.5%), subtotal or partial resection in 125 (37.5%), and biopsy only in 4 (1.2%). Recurrence or progression was observed in 6 of 25 patients (24.0%), and among 81 patients with available survival data, 50 (61.7%) died.
Conclusion:
Occipital lobe glial and glioneuronal tumors are rare and diverse, with most literature focusing on high-grade astrocytic tumors. Visual symptoms are the primary clinical feature. Surgical treatment should be tailored to balance oncological control with the risk of visual impairment. Consistent reporting on occipital sublocation, molecular diagnosis, visual results, resection extent, recurrence, and survival is essential for better future evidence synthesis.