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Unusual Optic Nerve Sheath Meningioma (Kennerdell Case 12). John S. Kennerdell, MD Chair, Department of Ophthalmology Allegheny General Hospital Professor, Ophthalmology Drexel University College of Medicine. Case Presentation.

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unusual optic nerve sheath meningioma kennerdell case 12

Unusual Optic Nerve Sheath Meningioma (Kennerdell Case 12)

John S. Kennerdell, MD

Chair, Department of Ophthalmology

Allegheny General Hospital

Professor, Ophthalmology

Drexel University College of Medicine

case presentation
Case Presentation
  • 39-year-old female c/o 6 year history of blurred vision OS, Darkening of vision in eccentric gaze OS, dark lines in vision OS
  • Vision: 20/20 OD 20/25 OS 9/1996
  • Ishihara: 12/12 OD 10/12 OS
  • Pupils: 3/3 RRL 2+ RAPD OS
  • Motility: 2+ abduction deficit OS,

8∆ esotropia, 20∆ esotropia L gaze

Unusual Optic Nerve Sheath MeningiomaSlide 1/18

case presentation1
Case Presentation
  • Exophthalmometry: No proptosis
  • SLE: Normal
  • DFE: OD: Disc Normal

OS: Moderate chronic disc edema

  • Macula/Retina: OD: Normal

OS: Choroidal folds

Unusual Optic Nerve Sheath MeningiomaSlide 2/18

slide4

An enlarged blind spot caused by the meningioma choking the left optic nerve.

Unusual Optic Nerve Sheath MeningiomaSlide 3/18

slide5

The left orbital meningioma non-contrast scan (right on this slide).

Unusual Optic Nerve Sheath MeningiomaSlide 4/18

slide6

The coronal view of the enhancing meningioma (right on this slide).

Unusual Optic Nerve Sheath MeningiomaSlide 5/18

treatment
Treatment
  • 10/7/96 to 11/13/96 Stereotactic XRT

28 fractions 5040 cGy

Intraorbital and intracranial ON

4MV Ph

Unusual Optic Nerve Sheath MeningiomaSlide 6/18

clinical followup
Clinical Followup
  • 8/1997: Followup Exam: 20/20 OU

“Disc pale”, choroidal folds

  • 5/1998: C/O enlarging scotoma, dim vision

20/20 OD 20/200 OS 0/12 plates

Persistent RAPD OS

Severe disc edema with macular and peripapillary exudates

Unusual Optic Nerve Sheath MeningiomaSlide 7/18

clinical followup1
Clinical Followup
  • 9/1998: Persistent poor vision

20/20 OD, 20/200 OS

Florid disc edema with macular

exudates OS, choroidal folds

  • MRI repeated, no radiographic progression

no new enhancement

Unusual Optic Nerve Sheath MeningiomaSlide 8/18

slide10

The severe disc edema that recurred.

Unusual Optic Nerve Sheath MeningiomaSlide 9/18

slide11

The severe central visual field defect of the left eye.

Unusual Optic Nerve Sheath MeningiomaSlide 10/18

slide12

The enhancing left optic nerve meningioma lesion with apparent fluid distal to the lesion abutting the globe (right side of slide).

Unusual Optic Nerve Sheath MeningiomaSlide 11/18

surgical therapy
Surgical Therapy
  • 9/17/98 Left lateral optic nerve sheath biopsy and fenestration
  • 6 hours post op: 20/20 OD, NLP OS

Pupil: dilated, nonreactive

  • Hospitalized for observation

solumedrol 250mg IV q6, 80mg pred taper

  • POD #1: 20/20 OD, 10/400 OS

Unusual Optic Nerve Sheath MeningiomaSlide 12/18

slide14

The lateral approach to the lesion without removing the left orbital rim.

Unusual Optic Nerve Sheath MeningiomaSlide 13/18

post operative followup
Post Operative Followup
  • POW #5: 20/20 OD, 20/25 OS

Persistent florid edema, macular exudates OS

Unusual Optic Nerve Sheath MeningiomaSlide 14/18

slide16

The post operative appearance of the lesion which is much smaller now. Note the slight adhesion of the optic nerve lesion to the lateral orbitotomy site (right on this slide).

Unusual Optic Nerve Sheath MeningiomaSlide 15/18

slide17

The post operative appearance of the patient.

Unusual Optic Nerve Sheath MeningiomaSlide 16/18

slide18

The marked improvement of the visual field with the vision returning again to 20/20.

Unusual Optic Nerve Sheath MeningiomaSlide 17/18

slide19

The marked reduction in temporal edema following the left optic nerve sheath decompression anterior to the lesion.

Unusual Optic Nerve Sheath MeningiomaSlide 18/18

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