Surgery is not the first-line treatment option for patients with optic nerve glioma. Surgical excision is usually reserved for patients with either progressive proptosis, blindness, exophytic chiasm tumor causing mass effect, hydrocephalus, or with increased intracranial pressure.

• Usually surgery is not preferred for this type of tumor, but it can sometimes improve vision and/or relieve symptoms.
• If the glioma causes an increase in intracranial pressure, excision may be required.
• Surgery is not recommended among patients with residual vision.
• Surgical treatment for optic pathway gliomas usually involves either excision or biopsy of the tumor.
• Surgery is the first choice when single nerve involvement is causing either progressive disfiguring proptosis, blindness, or an exophytic chiasm tumor is causing mass effect or hydrocephalus.^[1]
• Diffuse infiltration of the chiasm is a contraindication to surgery.
• Due to damage the risk of visual loss as well as damage to surrounding neurologic structures, surgical intervention for gliomas involving the optic chiasm is considered only for obtaining a biopsy specimen of the chiasm in certain cases or for relieving hydrocephalus.
• NF-1 patients have increased risk of local recurrence after surgery than non-NF patients and tend to have less localized disease.