Meningioma del Tubérculo Selar: Foraminotomía Óptica Precoz Por Vía Pterional Transsilviana / Sellar Tubercle Meningioma: Early Optic Foraminotomy By Transsylvian Pterional Route

Introducción: Los meningiomas constituyen aproximadamente el 10-15%1 de las neoplasias cerebrales, y el 7% de ellos presentan una inserción supraselar. Los meningiomas del tubérculo selar presentan adherencia en este, en el surco quiasmático o en el limbo esfenoidal2,3. Descripción del caso: Mujer de 45 años que consulta por cefalea y déficit severo de la visión del ojo izquierdo, constatado por campimetría visual. En RM se observa imagen extraaxial, en relación al tubérculo selar, con lateralización hacia la izquierda, ingresando al conducto óptico de ese lado. Se realizó abordaje pterional izquierdo, con acceso transsilviano a las cisternas óptica y carotídea izquierdas. Se individualiza la lesión color parduzca en el espacio interóptico, que desplaza hacia lateral y superior el nervio óptico izquierdo. Se retira duramadre que cubre el techo del conducto óptico y luego con fresa diamantada se descomprime4 el mismo de modo precoz, antes de la disección microquirúrgica del meningioma. Con aspirador ultrasónico se lleva a cabo el vaciamiento intratumoral, y luego separamos la capsula tumoral de la aracnoides y las estructuras neurales y vasculares. Luego de la exéresis completa de la lesión, se retira duramadre del tubérculo selar y se realiza fresado del mismo para evitar recurrencias en el sitio de implantación. Resultados: En RM postoperatoria se observa resección completa de la lesión; además la paciente refiere mejoría notoria de su visión que se constata en examen físico. Se confirma dicha mejoría en campimetría visual a los 3 meses postoperatorios. Conclusión: La descompresión precoz del conducto óptico en los meningiomas del tubérculo selar es una maniobra quirúrgica útil para prevenir una mayor lesión del nervio durante la extirpación del tumor; además permite resecar fragmentos intracanaliculares.

Introduction: Meningiomas constitute approximately 10-15%1 of the brain neoplasms and 7% of them present a suprasellar insertion. The meningiomas of the sellar tubercle present adherence in its, in the chiasmatic sulcus or sphenoid limbus2,3. Case description: A 45-year-old woman consulted for headache and severe vision deficit of the left eye, confirmed by visual field campimetry. In MRI an extraaxial image is observed, in relation to the sellar tubercle with lateralization to the left, entering the optic canal. A left pterional approach was performed, with transsylvian access to the left optic and carotid cisterns. The brownish lesion is individualized in the interoptic space, which displaces laterally and superiorly the optic nerve. The dura mater that covers the roof of the optic canal is removed at the beginning of the surgery, and then, with a diamond bur, the optic canal is decompressed4, before the microsurgical dissection of the meningioma. With an ultrasonic aspirator, the tumor debulking is carried out, and then the tumor capsule was separated from the arachnoid and the neural and vascular structures. Finally, the duramater of the tuberculum sellae was removed and the tubercle was drilled to avoid recurrences at the implantation site. Results: In a postoperative MRI, complete resection of the lesion was observed. The patient reported a noticeable improvement in her vision that was confirmed by a physical examination. Confirming this improvement in visual field campimetry was done 3 months postoperatively. Conclusion: Early decompression of the optic canal is essential to avoid further injury during tumor removal of a tuberculum sellae meningioma, as well as allowing the resection of intracanalicular fragments.

Optic neuropathy secondary to dasatinib in the treatment of a chronic myeloid leukemia case.

The drug dasatinib is a new therapeutic option for patients with chronic myeloid leukemia (CML) as well as acute lymphocytic lymphoblastic leukemia (ALL). However, the scientific literature has not reached a consensus regarding the types of secondary ophthalmologic effects that this drug may have. In this study, we present the case of a 36-year-old male patient who was treated with dasatinib. Two and a half months later, this patient began to experience progressive visual loss in the superior visual field of both eyes. After ruling out various diagnostic options and performing extensive complementary tests, the suspected diagnosis was compatible with optic neuropathy secondary to dasatinib. The patient partially improved after stopping this medication and receiving oral corticosteroid treatment. Although secondary ophthalmological effects related to dasatinib are practically non-existent, our case is the first to report optic neuropathy secondary to this drug.