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1.
Ophthalmic Plast Reconstr Surg ; 22(4): 278-82, 2006.
Article in English | MEDLINE | ID: mdl-16855500

ABSTRACT

PURPOSE: To describe a role for optic nerve decompression as adjuvant surgical therapy in the management of optic nerve sheath meningioma in patients with severe, progressive visual loss and optic disc edema before or after radiation therapy. METHODS: Interventional case report. RESULTS: Two patients with unilateral optic nerve sheath meningioma had progressive visual loss (20/200 and no light perception) and disc edema. The first had previously undergone fractionated stereotactic radiotherapy and the second subsequently was treated with fractionated stereotactic radiotherapy after decompression surgery. After excision of a dural window and biopsy of the tumor from the nerve sheath, visual acuity improved to 20/25 and 20/200, respectively, both coinciding with resolution of disc edema. CONCLUSIONS: In patients with optic nerve sheath meningioma with severe disc edema and rapid vision loss, surgery may serve an important but restricted, adjuvant role to radiation therapy under special conditions.


Subject(s)
Decompression, Surgical , Meningioma/surgery , Nerve Sheath Neoplasms/surgery , Optic Nerve Neoplasms/surgery , Adult , Female , Humans , Magnetic Resonance Imaging , Meningioma/pathology , Meningioma/radiotherapy , Nerve Sheath Neoplasms/pathology , Nerve Sheath Neoplasms/radiotherapy , Optic Nerve Neoplasms/pathology , Optic Nerve Neoplasms/radiotherapy , Papilledema/diagnosis , Vision Disorders/diagnosis
2.
Ophthalmic Plast Reconstr Surg ; 21(5): 387-9, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16234708

ABSTRACT

A 71-year-old-man presented with chronic left-sided epiphora and a 5-day history of progressive left orbital swelling that had started with a "bump" on the left side of his nose. Orbital CT revealed left-sided preseptal and postseptal inflammation, along with marked thickening of the left superior ophthalmic vein. Orbital MRI with gadolinium enhancement and fat suppression revealed a low-intensity signal in the left superior ophthalmic vein, consistent with a superior ophthalmic vein thrombosis. There was no cavernous sinus involvement. A diagnosis was made of left-sided dacryocystitis-induced orbital cellulitis and superior ophthalmic vein thrombosis. Treatment consisted of intravenous vancomycin, followed by early dacryocystorhinostomy and postoperative intravenous dexamethasone. Anticoagulation was not used. Within 1 week after surgery, the orbital congestion had dramatically improved. Though rare, isolated superior ophthalmic vein thrombosis can be a harbinger of cavernous sinus thrombosis; therefore, early detection is the key to avoiding cavernous sinus thrombosis.


Subject(s)
Cellulitis/etiology , Dacryocystitis/complications , Orbital Diseases/etiology , Veins , Venous Thrombosis/complications , Aged , Cellulitis/diagnosis , Cellulitis/therapy , Combined Modality Therapy , Dacryocystitis/diagnosis , Dacryocystitis/therapy , Dacryocystorhinostomy , Dexamethasone/therapeutic use , Eye/blood supply , Humans , Magnetic Resonance Imaging , Male , Orbital Diseases/diagnosis , Orbital Diseases/therapy , Tomography, X-Ray Computed , Vancomycin/therapeutic use , Venous Thrombosis/diagnosis , Venous Thrombosis/therapy
3.
Ophthalmology ; 109(5): 890-9; discussion 899-900, 2002 May.
Article in English | MEDLINE | ID: mdl-11986093

ABSTRACT

PURPOSE: Comparison of treatment outcome in patients with primary optic nerve sheath meningioma (ONSM). DESIGN: Retrospective, nonrandomized, comparative interventional case series. PARTICIPANTS: Sixty-four patients with at least 50 months of well-documented follow-up. INTERVENTION: Observation, surgery only, radiotherapy only, or surgery and radiotherapy. MAIN OUTCOME MEASURES: Visual acuity expressed as ratio, radiographic progression, and treatment complications. RESULTS: Sixty-four patients (55 women [85.9%] and nine men [14.1%]) were followed for a mean of 150.2 months (range, 51-516 months; standard deviation [SD], 74.7). The mean age at diagnosis was 47.1 years (range, 17-81 years; SD, 15.4). Fifty-eight patients had unilateral disease and six patients had bilateral disease. Of 59 patients with vision greater than no light perception at diagnosis, 13 patients were observed only, 12 had surgery only (four biopsies or partial resections, eight total resections), 18 received radiation alone, and 16 had surgery and radiation (14 biopsies or partial resections and radiation, two total resections and radiation). Irradiated patients received 4000 to 5500 cGy of conventional multiport or conformal external beam therapy, typically fractionated over 6 weeks. Visual acuity measurements at diagnosis among the four groups were not different (ratio, P = 0.186). Visual acuity at diagnosis was > or =0.5 in 56.3%, 0.4 to 0.050 in 12.5%, and <0.050 in 31.3%. Visual acuity measures at last follow-up were different among the four groups (ratio, P = 0.004). At last follow-up the acuity was > or =0.5 in 28.1%, 0.4 to 0.050 in 15.6%, and <0.050 in 56.3%. Visual acuity fell significantly for the observed only (ratio, P = 0.002), surgery only (ratio, P = 0.019), and surgery with radiation groups (ratio, P = 0.030). The radiation only group showed a decrease in visual acuity that was not significant (ratio, P = 0.301). Complication rate was 33.3% in radiation only cases, 66.7% in surgery only cases, and 62.5% in surgery with radiation cases. Twenty-one patients (32.8%) showed radiographic progression. Four patients who were observed, seven patients who had surgery alone, and eight patients who had surgery and radiation developed radiographic progression. Two patients who had radiation alone had radiographic progression before treatment. Only two patients treated with radiation only showed radiographic progression after radiotherapy, and both had at least one surgical procedure before the radiotherapy. CONCLUSIONS: Patients with ONSM receiving radiation alone demonstrated the best visual outcome during the follow-up period. We recommend that fractionated external beam radiation (5000-5500 cGy) be considered as initial treatment in adults in selected cases of ONSM when preservation of visual function is a reasonable therapeutic goal.


Subject(s)
Meningioma/radiotherapy , Meningioma/surgery , Nerve Sheath Neoplasms/radiotherapy , Nerve Sheath Neoplasms/surgery , Optic Nerve Neoplasms/radiotherapy , Optic Nerve Neoplasms/surgery , Visual Acuity , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Disease Progression , Dose Fractionation, Radiation , Female , Follow-Up Studies , Humans , Male , Meningioma/physiopathology , Middle Aged , Nerve Sheath Neoplasms/physiopathology , Observation , Optic Nerve Neoplasms/physiopathology , Radiotherapy, Conformal , Retrospective Studies , Treatment Outcome
4.
Neurosurgery ; 50(5): 1129-31; discussion 1131-2, 2002 May.
Article in English | MEDLINE | ID: mdl-11950417

ABSTRACT

OBJECTIVE AND IMPORTANCE: Suprasellar meningiomas typically cause bitemporal hemianopsia by direct compression of the chiasm, its blood supply, or both. We report another mechanism for visual loss in suprasellar meningiomas, whereby compression by the suprajacent vascular complex is the offending agent. CLINICAL PRESENTATION: A 78-year-old woman with a suprasellar meningioma was diagnosed incidentally. During the follow-up period, she developed an inferior homonymous wedge defect consistent with superior compression, without any detectable radiological progression. It was decided to resect her tumor. INTERVENTION: The patient underwent a fronto-orbital approach for tumoral excision. Intraoperatively, a groove by the anterior cerebral artery complex was found along the superior surface of the chiasm. Postoperatively, the patient's visual deficit resolved. CONCLUSION: This case illustrates an unusual visual field deficit associated with a suprasellar meningioma. It also emphasizes the importance of frequent and careful visual field monitoring, which can precede radiological and symptomatic progression.


Subject(s)
Meningeal Neoplasms/complications , Meningioma/complications , Vision Disorders/etiology , Visual Fields , Aged , Cerebral Arteries/physiopathology , Female , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/physiopathology , Meningeal Neoplasms/surgery , Meningioma/physiopathology , Meningioma/surgery , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/etiology , Optic Chiasm/pathology , Sella Turcica
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