CASE REPORT Fractionated stereotactic radiotherapy using Novalis for confined intra-orbital optic nerve glioma in pediatric patient Seong Rok Han & Keung Nyun Kim & Gi-Taek Yee & Chan Young Choi & Dong Joon Lee & Moon Jun Sohn & Chae Heuck Lee Received: 2 September 2012 / Accepted: 11 January 2013 / Published online: 22 January 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Introduction Optic gliomas are the most common tumors in the optic pathways during childhood. Among them, about 10 % are located within intra-orbital cavity. However, the optimal management for intra-orbital optic nerve gliomas remains controversial. An 11-year-old male complained about progressive decline of vision in his right eye. Brain MRI revealed a fusiform enlargement of right optic nerve within intra-orbital cavity. Materials and methods A presumptive diagnosis of optic nerve glioma was made. Therefore, we performed fraction- ated stereotactic radiotherapy (FSRT) using Novalis. Discussion Five years after FSRT treatment, follow-up MRI revealed size reduction of tumor and visual acuity improve- ment without radiation-related complications. Keywords Fractionated stereotactic radiotherapy . Optic glioma . Novalis Introduction Optic gliomas may occur at any age; however, childhood is the most common period of life for these tumors [1–4]. The most common histologic entity in children is low-grade astrocytoma, and about 10–70 % are associated with neuro- fibromatosis type 1 (NF1) [4, 5]. Optic gliomas can be localized directly behind the eye or anywhere along the optic pathway as far as the occipital cortex. About 10 % are located within intra-orbital optic nerve, 20–40 % involve the chiasm with or without the optic nerve, and 33–60 % in the hypothalamic tract with or without the optic tract are affected [4, 5]. Optic gliomas are usually slow-growing tumors that sometimes regress spontaneously, but can occasionally progress rapidly [1, 4]. Among them, optic gliomas without NF1 were more progressive and showed fewer spontaneous regressions [6]. Therefore, timely treatment and the optimal management for optic gliomas remain controversial. Close observation, surgery, chemotherapy, and radiotherapy (RT), or any combinations of these are suggested for patient management [3, 4]. Here, we report confined intra-orbital optic nerve glioma in pediatric patient without NF1 who was treated with fractionated stereotactic radiotherapy (FSRT) using Novalis (BrainLAB AG, Heimstetten, Germany). Case report An 11-year-old male was admitted to our hospital complain- ing of progressive right side visual disturbance from 1 year ago. Ophthalmological examination showed that the cor- rected best visual acuity was 20/63 in the right eye, and funduscopic finding of right eye showed a slightly edema- tous optic disk. Humphrey visual field examination in right eye indicated depressed visual field in the periphery and temporal area. On physical examination, there were no Lisch nodules or other stigmata of NF1. The brain MRI revealed a fusiform enlargement of the right optic nerve S. R. Han (*) The Graduate School, College of Medicine, Yonsei University, Seoul, South Korea e-mail: hsrkmj@paik.ac.kr K. N. Kim Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, South Korea G.-T. Yee : C. Y. Choi : D. J. Lee : M. J. Sohn : C. H. Lee Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea Childs Nerv Syst (2013) 29:867–871 DOI 10.1007/s00381-013-2031-x