A rare case of bilateral optic nerve sheath meningioma

AJNR. American journal of neuroradiology, 1996

Cancer control : journal of the Moffitt Cancer Center

Primary and secondary optic nerve sheath meningiomas (ONSMs) are neoplasms that account for a large proportion of optic nerve and orbital tumors. The diagnosis is not always straightforward and is based on the appropriate clinical findings and neuroimaging. Biopsy or surgical intervention may occasionally be necessary but is associated with significant morbidity. Issues related to clinical signs and symptoms, diagnosis, natural history, and treatment strategies are reviewed based on a review of published literature. Diagnosis is usually based on radiographic and clinical findings. Biopsies are not obtained in most cases, thus adding further to the bias of possible misdiagnosis in all reported case series that do not have the benefit of histopathologic confirmation. Natural history typically shows inexorable progression in most cases, although long periods of stability are occasionally reported. Treatment options include observation, radiation alone, surgery alone, and combined radia...

Journal of Neurosurgery, 2004

Object. The management of optic nerve sheath meningiomas (ONSMs) remains controversial but includes surgery, radiotherapy, and plain observation. Surgery is often thought to result in postoperative blindness. The authors report on a large series of patients surgically treated for ONSM, with an emphasis on the visual outcome. Methods. Seventy-three patients with ONSMs who had undergone surgery between 1991 and 2002 were retrospectively analyzed. The standard surgical approach consisted of pterional craniotomy, intradural (54 patients) or extradural (10 patients) unroofing of the optic canal, or a combined procedure (seven patients). Thirty-two tumors demonstrated extension through the optic canal. Twenty-nine tumors reached the chiasm or contralateral side. Patients with intraorbital flat tumors should undergo radiotherapy instead of surgery. Those with a large intraorbital mass and no useful vision should undergo surgery. Tumors extending intracranially through the optic canal are a...

American Journal of Neuroradiology

We describe six cases of cannalicular optic nerve meningioma in which the diagnosis was missed for more than 1 year after the onset of symptoms. Clinical features led to a misdiagnosis of optic neuritis in all cases. Although atypical clinical progression led to further imaging studies, they did not provide the diagnosis because of inappropriate imaging protocols. Diagnosis was eventually made on the basis of high-spatial-resolution contrast-enhanced MR findings. Radiologists should have a high suspicion for the diagnosis of optic canal meningioma in patients with unexplained visual loss, particularly when visual loss is progressive. Investigation in these cases should include high-spatial-resolution MR imaging of the orbit before and after contrast medium administration, and fat suppression should be used in combination with contrast enhancement whenever possible.

2014

SUMMARY Primary optic nerve sheath meningiomas (ONSM) are rare tumors of optic nerve which account for approximately 5-10% of orbital neoplasms. The classic triad of optic atrophy, progressive visual loss and presence of opticociliary shunt vessels is pathognomonic for the clinical presentation of ONSM however only a few percent of cases has this classic presentation. The most common presenting symptom in these patients is painless, progressive loss of visual acuity and dyschromatopsia. On clinical examination pathologic appearance of optic disc with varying degrees of optic atrophy is commonly observed. The goal of treatment for cases of ONSM is tumor control and improvement of vision. In cases with small and non-progressive tumor and high functional vision, conservative follow-up of the lesion is appropriate since surgical excision of ONSM is generally associated with high visual morbidities. Here we present a 67-year-old female patient with primary ONSM located on retrobulbar spa...

AJNR. American journal of neuroradiology

We describe six cases of cannalicular optic nerve meningioma in which the diagnosis was missed for more than 1 year after the onset of symptoms. Clinical features led to a misdiagnosis of optic neuritis in all cases. Although atypical clinical progression led to further imaging studies, they did not provide the diagnosis because of inappropriate imaging protocols. Diagnosis was eventually made on the basis of high-spatial-resolution contrast-enhanced MR findings. Radiologists should have a high suspicion for the diagnosis of optic canal meningioma in patients with unexplained visual loss, particularly when visual loss is progressive. Investigation in these cases should include high-spatial-resolution MR imaging of the orbit before and after contrast medium administration, and fat suppression should be used in combination with contrast enhancement whenever possible.

Czech and Slovak Ophthalmology

OPTIC NERVE ORBITAL MENINGIOMA Introduction: Orbital meningioma treatment has achieved significant success over the last period. Primary optic nerve sheath meningiomas by the clinically progressive finding, but still persistent sufficient visual acuity, can be treated by fractionated stereotactic radiotherapy. Surgery is indicated for secondary meningiomas of the orbit. Surgical treatment is indicated due to intracranial tumor propagation of meningioma from the chiasm towards the orbit. Material and methods: In the period 2014-2016 we monitored in dispensary 15 patients with meningioma of the orbit, who were checked at least in yearly intervals and underwent magnetic resonance examination of the orbit and brain. Results: In group of 15 patients with histologically unverified meningioma of the orbit, the surgical solution was indicated in 3 patients. In 14 (93.3%) patients meningiomas were secondary infiltrating orbit from the intracranial part of visual pathways, and in 1 case meningioma was primary arising from the optic nerv. We indicated enucleation and partial exenteration in 3 (20%) patients. Histopathological examination confirmed meningioma-in two cases gr. I., in one patient gr. II. In all of them, more than 5 years after the primary diagnose of the process, the tumor infiltration from the chiasm towards the orbit was the indication for surgery. In one patient with meningioma gr. II in 12 months interval after surgery-exenteration with lid sparing technique, there was a further progression from the sella turcica area and the growth of tumor masses to the area of the orbital conus. Patient underwent secondary surgical reduction of tumor mass of the orbit and treatment with sandostatin. Conclusion: When deciding to treat meningioma, it is necessary to involve multidisciplinary collaboration. Ophthalmology examination is important because further treatment is indicated on the basis of changes in visual function in correlation with the imaging methods. In cases of progression of the tumor with the infiltration of the orbit, resulting in the loss of visual acuity, in certain conditions a radical solution-enucleation with partial exenteration of the orbit, is necessary.

Eye, 1996

A 37-year-old woman presented with acute left-sided proptosis. Magnetic resonance imaging demonstrated a solid intraconal mass lesion with an associated 'capping'

Journal of Neuro-Ophthalmology, 2007

Journal of neurological surgery reports, 2017

Optic nerve sheath meningiomas (ONSMs) account for less than 2% of meningiomas and 1.7% of orbital tumors. Although rare, the management of these tumors is important as unilateral blindness often results in untreated cases. Radiotherapy has emerged as the preferred treatment. However, therapies for ONSMs are controversial due to the variable natural history of the disease and limitations of surgical and radiotherapy options. A 60-year-old woman presented with monocular left diminished color perception and blurred vision. Magnetic resonance imaging demonstrated a homogenously enhancing 5-mm left optic nerve mass with evidence of nerve compression. Conservative management was advised. However, 1 month after diagnosis her visual acuity deteriorated further. Because of the small focal location of the tumor within the optic canal, surgery was considered. Given the tumor's location inferomedial to the optic nerve, an endoscopic endonasal approach to the optic canal was performed. This...

American Journal of Ophthalmology, 2004

OBJECTIVE: Surgical strategies and results for 50 patients with meningiomas involving the optic nerves are discussed and evaluated. Factors affecting the degree of resection and patient outcomes are presented. We emphasize our surgical techniques for resection of these tumors and we discuss the advantages of different approaches, depending on the relationship of the tumor to the optic nerves. METHODS: Data for 50 patients with meningiomas involving the optic nerves who were surgically treated between 1991 and 2002 were reviewed, by using patient files, operative notes, and pre-and postoperative imaging and ophthalmological examination findings. RESULTS: Thirty-one female patients and 19 male patients, with a mean age of 53 years, were treated. Thirty-one patients (62%) underwent complete tumor removal (Simpson Grade 1 or 2), and 19 patients underwent subtotal removal (Grade 4). Factors affecting the grade of resection were tumor size (P ϭ 0.01), location (P ϭ 0.007), and internal carotid artery encasement (P ϭ 0.019). Patients who underwent Grade 1 or 2 resection exhibited a mean tumor size of 3.0 cm, and patients who underwent Grade 4 resection exhibited a mean tumor size of 4.1 cm. Only three patients had residual tumor on the optic nerve; all others had tumor in the cavernous sinus or at the orbital apex or exhibited vascular involvement. Visual outcomes were influenced predominantly by tumor size, preoperative visual function, and optic nerve encasement. CONCLUSION: Meningiomas that involve the optic nerves require special considerations and surgical techniques. Early decompression of the optic nerve within the bony canal allows identification and separation of the tumor from the nerve, permitting removal of the tumor from this area with minimal manipulation of the optic nerve.

International Medical Case Reports Journal, 2015

Primary optic nerve sheath meningioma (PONSM) is extremely rare among children. We report two cases of pediatric PONSM. The first case was a 12-year-old boy who presented with gradual visual loss of his right eye and was found to be associated with neurofibromatosis type 2. The second case was a 10-year-old boy who presented with gradual proptosis of his left eye with normal visual acuity. Severe visual loss is a common clinical manifestation of pediatric PONSM. Although the visual acuity in the second case was normal, his vision rapidly deteriorated to 20/200. In both cases, the diagnosis of PONSM was confirmed by magnetic resonance imaging, and a successful tumor growth control was achieved after stereotactic radiotherapy was implemented.

Neurosurgical …, 2011

V isual disturbance due to optic nerve compression is the initial presentation for many patients with anterior and middle fossa meningiomas. Optic nerve compression is variable depending on the size and the location of the tumor; bilateral optic nerve involvement and optic chiasm compression further add to the complexity of the surgical decision-making process. 2,4,9,19,25,26,28,31 Optic canal involvement by these tumors is not rare, and reports have described unilateral or bilateral optic canal extension. 2-4,32 The primary goal of surgery is total removal of the tumor, with improvement or preservation of the preoperative visual status. 1-3,24,26,28 In this setting, complete nontraumatic decompression of the optic pathway is of paramount concern, with particular attention paid to the full preservation of the attendant delicate blood supply of the optic nerve and chiasm. 2,3,8,21,24,27 Several reports have addressed the prognostic criteria for visual recovery in patients with these tumors, with series documenting a 25% to 80% chance of visual improvement depending on tumor size, location, extension, preoperative visual status, duration of symptoms, and the surgical technique. 1,2,4,5,7,19,25,26,29,30 Optic canal decompression is an important step to optimize visual recovery and Meningiomas involving the optic canal: pattern of involvement and implications for surgical technique

Journal of Clinical Neuroscience, 2010

a b s t r a c t Primary optic nerve sheath meningiomas (ONM) are rare. Most of these are World Health Organization Grade I meningiomas. Because of the intimate relationship to the optic nerve sheath from which they arise, radical excision is often not feasible. The chordoid variant of meningioma is an infrequent tumor and extremely uncommon among primary ONMs. We report a 36-year-old woman with painless proptosis and normal visual acuity who presented to us with an exophytic intraconal mass, which was excised. Histology revealed a chordoid meningioma. We could find only two previous reports, which are discussed.

Neurosurgical Review, 1997

Optic sheath meningocele is rare; only approximately 31 cases have been reported. The term optic sheath meningocele has recently been proposed by Garrity and Forbes to describe primary CSF cysts of the optic nerve sheath, without apical mass or malformation of the cranio-orbital junction. Presenting symptoms are often related to involvement of the optic nerve, with a slow or rapid decrease of visual acuity.