A Case of Meningioma Masquerading as Ischemic Optic Neuropathy

PURPOSE: We report a case of meningioma diagnosed as ischemic optic neuropathy. CASE SUMMARY: A 45-year-old women presented with decreased visual acuity in her left eye without eye movement pain. Her best corrected visual acuity (BCVA) in that eye was 0.3. She showed a relative afferent pupillary defect, abnormal color vision test, and inferior visual field defect in her left eye. The optic disc showed slight blurring superiorly and pallor temporally. Fluorescein angiography showed choroidal filling defect, and ischemic optic neuropathy was suspected. The carotid artery sonography showed normal results. The BCVA of the left eye was 0.5 after 7 months. The visual field test and color vision test were improved after 7 months. The optic disc was pale. The magnetic resonance imaging was performed because of persistent headache, and that showed a suprasellar mass that was removed by surgical resection and diagnosed as meningioma on biopsy. CONCLUSIONS: The possibility of compressive optic neuropathy should be considered in presumed ischemic optic neuropathy if the patient complains of persistent headache.

The importance of ophthalmic signs in the diagnosis of suprasellar meningioma- a case report

A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.

Surgical Management of Suprasellar Meningioma

OBJECTIVE: Suprasellar meningioma have in general been difficult lesions to treat because of their vicinity to the optic apparatus and major vessels, and high vascularity. This study was performed to analyze clinical outcome of patients with histopathologically identified suprasellar meningioma. METHOD: Between 1989 and 1998, 37 patients(30 women, 7 men: average 47.5years) with histopathologically identified meningiomas originating from the suprasellar region underwent surgical tumor removal in our institution. The medical records and clinical data of these patients are retrospectively analyzed. RESULT: The tumor size ranged from 2.1cm to 6.5cm(average 5.1cm) in diameter. The tumors have been approached basically through the pterional and bifrontal routes. Skull base technique was also applied in large or complicated cases. Total resection rates and overall outcome including visual function was better in patients with tumor of less then 3cm. A considerable increase of mortality, morbidity and failure of visual improvement were seen in case of the tumors size of 3cm or more. CONCLUSION: Early diagnosis and treatment were important factors in the successful management of these suprasellar meningioma. In large complicated cases encasing major vessels or invading cavernous sinus or anterior skull base, surgeons need to operate with extreme caution and piecemeal removal of the tumor without injuring optic apparatus and major vessels utilizing skull base technique.

Visual Recovery with Surgical Managment of Suprasellar Meningioma

The visual outcome in consecutive 16 cases of suprasellar meningioma treated during the past 7 years was reivewed. Progressive visual loss, the most frequent initial complant(93.8%), occurred over a mean of 35.4 months, was often unilateral(6 patients) or bilateral but asymmetrical(6 patients) and was severe in 12 cases. All 16 patients hadvisual field abnormalities. There were 9 patients with tumors lager than 3cm in diameter and 7 patients with tumors less than 3cm in diameter. Four patients had tumors limited to the tuberculum sellae. The tumors extended from the tuberculum sellae onto the planum sphenoidale in four patients. into one optic canal in three patients, onto the diaphragm sellae in four patients and onto the medial sphenoid wing in one patient. Three tumors were incompletely resected(one involoving the medial sphenoid wing, one involving the diaphragm sellare and one involving the lanum sphenoidale). There was one operative death. Overall, 73% of patients had improved vision postoperatively, 27% remained unchanged. Tumor invoving the diaphragm sellae was associated with postoperative visual field deterioration. The visual outcome was affected by the severity of preoperative visual loss but not by the tumor size and duration of visual symptom. After a mean follow-up of 14.5 months, 15 patients are performing normal activities with improved vision.

Microsurgical Treatment of Suprasellar Meningiomas

Suprasellar meningiomas are uncommon intracranial tumors representing approximately 4-10% of intracranial meningiomas and the total excision is sometimes hazardous because of surrounding vital structures. We have experienced four cases of this lesion during last three years and the masses were approached through frontoparietal craniotomy and lateral subfrontal approach and were removed completely with microsurgical technique. Visual disturbances were improved in three cases and unchanged in one case. The literatures are also reviewed.