| Subject |
Diagnosis, Differential; Exophthalmos, diagnosis; Exophthalmos, etiology; Female; Humans; Meningioma, complications; Meningioma, diagnosis; Meningioma, surgery; Middle Older people; Nerve Sheath Neoplasms, complications; Nerve Sheath Neoplasms, diagnosis; Nerve Sheath Neoplasms, surgery; Optic Nerve Neoplasms, complications; Optic Nerve Neoplasms, diagnosis; Optic Nerve Neoplasms, surgery; Tomography, X-Ray Computed |
| OCR Text |
Show PHOTO ESSAY Cystic Optic Nerve Sheath Meningioma Tatiana I. Rosea, MD, PhD, Benone D. Carstocea, MD, PhD, Teodora Gh. Vladescu, MD, Cecilia St. Tihoan, MD, and Gheorghe- Gabriel Gh. Gherghescu, MD FIG. 1. A and B. Marked proptosis and inferior displacement of the left eye caused by orbital mass. C and D. Axial CT shows a large cystic mass in the superotemporal left orbit ( A) with a solid portion visible more interiorly ( B). paretic. The vision in the eye gradually diminished until 1978, when the eye was completely blind ( Fig. 1, A and B). In 2003, CT revealed marked left proptosis associated with a large cystic structure occupying much of the orbit ( Fig. 1, C and D). Because of the marked proptosis, it was elected to explore the orbit and excise the cyst. At surgery, a large, partially cystic mass was identified that was adherent to the posterior two- thirds of the left optic nerve ( Fig. 2). The cystic portion of the mass contained yellowish, jelly- like material. On histopathologic examination, the mass was found to be a meningothelial meningioma with cyst formation that was compressing rather than infiltrating the adjacent optic nerve ( Fig. 3). After surgery, the proptosis had resolved ( Fig. 4). Arachnoid cysts of the optic nerve are rare causes of proptosis, visual loss, or both. Some appear to be isolated congenital anomalies ( 1) whereas others are associated with optic nerve sheath meningiomas ( 2). In our case, an optic J Neuro- Ophthalmol, Vol. 26, No. 2, 2006 121 Abstract: A 58- year- old woman with a 35- year history of left proptosis underwent neuroimaging that revealed a large cystic lesion. Surgery revealed an optic nerve sheath meningioma associated with cyst formation. The cyst was part of the tumor, a phenomenon that is well described in intracranial meningiomas but not in optic nerve sheath meningiomas. (/ Neuro- Ophthalmol 2006; 26: 121- 122) A 58- year- old woman had left proptosis in 1966. She initially had normal vision in the eye, but over the ensuing years, the eye became increasing proptotic and Clinical Emergency Sf. Pantelimon Hospital ( TIR, TOY CST, GGGG) and Emergency Military Hospital ( BDC), Bucharest, Romania. Address correspondence to Tatiana Rosea, MD, PhD, Str. Gala Galaction nr. 59, Sector 1, Bucuresti, Romania; E- mail: rosca_ tatiana@ yahoo. com J Neuro- Ophthalmol, Vol. 26, No. 2, 2006 FIG. 2. Surgical specimen of resected mass with associated cyst. FIG. 3. Histopathology shows ( A) meningothelial cells associated with cyst formation ( hematoxylin and eosin stain, x10) and ( B) psammoma bodies ( hematoxylin and eosin stain, x40). Rosea et al FIG. 4. Two years after surgery, the proptosis is gone. nerve sheath meningioma was associated with cyst formation within the tumor itself, a phenomenon that is well described in intracranial meningiomas ( 3) but not in optic nerve sheath meningiomas. REFERENCES 1. Akor C, Wojno TH, Newman NJ, et al. Arachnoid cyst of the optic nerve: report of two cases and review of the literature. Ophthal Plast Reconstr Surg 2003; 19: 466- 9. 2. McNab AA, Wright JE. Cysts of the optic nerve: three cases associated with meningioma. Eye 1989; 3: 355- 9. 3. Jung TY, Jung S, Shin SR, et al. Clinical and histopathological analysis of cystic meningiomas. J Clin Neurosci 2005; 12: 651- 5. 122 © 2006 Lippincott Williams & Wilkins |
