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A New Approach to an Old Problem☆

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Abstract

A patient with progressive visual loss was found to have an optic nerve sheath meningioma. The patient was treated with stereotactic radiotherapy, a computer-guided stereotactic technique that minimizes the risk of radiation-induced optic neuropathy. Six months after treatment, the patient was doing well and showed no signs of radiation-induced optic neuropathy.

Section snippets

Comments by Andrew G. Lee, MD, and David W. Andrews, MD

(In keeping with the format of a clinical pathological conference, the abstract and key words appear at the end of the article.)

Case Report. A 41-year-old man complained of painless, progressive, visual loss in the left eye during the preceding 3 years. His ophthalmologist was unable to correct the visual acuity in the left eye to better than 20/40, and he noted pallor of the left optic nerve head. Medical history was significant for a basal cell carcinoma of the right facial area, which had

Comments

Comments by Andrew G. Lee, MD, Division of Neuro-ophthalmology, Baylor College of Medicine, Houston, Texas, USA

This patient is a middle-aged man with painless, progressive, unilateral visual loss and clinical evidence of an optic neuropathy (i.e., decreased visual acuity and visual field, an ipsilateral relative afferent pupillary defect, and optic atrophy). The differential diagnosis for an optic neuropathy is long, and causes include ischemic (arteritic or nonarteritic anterior ischemic optic

Case Report (Continued)

Magnetic resonance imaging (MRI) with fat suppression of the orbits revealed the lesion shown in Fig. 2.

Comments (Continued)

Comments of Dr. Lee

The neuroimaging characteristics of the lesion are suggestive of an optic nerve sheath meningioma (ONSM). Computed tomographic (CT) scans and MRIs in ONSM usually demonstrate diffuse fusiform or tubular enlargement of the optic nerve. Computed tomographic scans may reveal peripheral calcification of the nerve sheath, “tram-tracking” along the optic nerve, or enlargement of the optic canal. Magnetic resonance images with gadolinium-DTPA and fat suppression techniques may allow

Case Report (Continued)

What are the treatment options, if any, for this patient?

Comments (Continued)

Comments of Dr. Lee

The ideal management of ONSM remains undefined, and conservative treatment is usually preferred because of the characteristic slow and indolent growth pattern and the extremely low mortality rates of these tumors. The treatment options include observation or hormonal, radiation, or surgical therapy.11 Untreated patients usually experience progressive visual loss. Experience with hormonal therapy for meningiomas has been extremely limited and unimpressive and is still

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    The authors have no proprietary interest in products or techniques described in this article.

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