Atypical orbital primary optic nerve sheath meningioma with severe disfiguring proptosis: an alternative surgical approach
Primary optic nerve sheath meningioma is generally a benign tumor. In rare instances, however, the growth rate and intraocular and intracranial extensions can be highly aggressive, especially in children, leading to poor prognosis. Here, we reported a case of a 24-year-old woman who presented with left eye swelling for 3 years. This was associated with blurred vision, retrobulbar pain, and redness. On examination, the left eye was severely proptosed with complete ophthalmoplegia. Magnetic resonance imaging showed an extensive tumor occupying the whole left orbital cavity with a disfigured eyeball. However, no intracranial extension was observed. Interestingly, complete surgical excision was feasible via transconjunctival anterior orbitotomy without bone removal. The histopathological examination confirmed the diagnosis of optic nerve sheath meningioma. Adjunct radiotherapy was given. On a follow-up after 2 years, left enophthalmos with esotropia was observed.
Douglas VP, Douglas KAA, Cestari DM. Optic nerve sheath meningioma. Curr Opin Ophthalmol. 2020;31(6):455-61. https://doi.org/10.1097/ICU.0000000000000700
Parker RT, Ovens CA, Fraser CL, Samarawickrama C. Optic nerve sheath meningiomas: prevalence, impact, and management strategies. Eye Brain. 2018;10:85-99. https://doi.org/10.2147/EB.S144345
Dutton JJ. Optic nerve sheath meningiomas. Surv Ophthalmol. 1992;37(3):167-83. https://doi.org/10.1016/0039-6257(92)90135-G
Turbin RE, Pokorny K. Diagnosis and treatment of orbital optic nerve sheath meningioma. Cancer Control. 2004;11(5):334-41. https://doi.org/10.1177/107327480401100508
Shapey J, Sabin HI, Danesh-Meyer HV, Kaye AH. Diagnosis and management of optic nerve sheath meningiomas. J Clin Neurosci. 2013;20(8):1045-56. https://doi.org/10.1016/j.jocn.2013.03.008
Pandit R, Paris L, Rudich DS, Lesser RL, Kupersmith MJ, Miller NR. Long-term efficacy of fractionated conformal radiotherapy for the management of primary optic nerve sheath meningioma. Br J Ophthalmol. 2019;103(10):1436-40. https://doi.org/10.1136/bjophthalmol-2018-313135
Amoli FA, Mehrabani PM, Tari AS. Aggressive orbital optic nerve meningioma with benign microscopic features: a case report. Orbit. 2007;26(4):271-4. https://doi.org/10.1080/01676830601168835
Monteiro ML, Gonçalves AC, Siqueira SA, Gebrim EM. Optic nerve sheath meningioma in the first decade of life: case report and review of the literature. Case Rep Ophthalmol. 2012;3(2):270-6. https://doi.org/10.1159/000342261
Beccari S, Cima L, Posenato I, Sala F, Ghimenton C, Brunelli M, et al. Pediatric optic nerve sheath meningioma. J Neuroophthalmol. 2014;34(3):315-6. https://doi.org/10.1097/WNO.0000000000000126
Eddleman CS, Liu JK. Optic nerve sheath meningioma: current diagnosis and treatment. Neurosurg Focus. 2007;23(5):E4. https://doi.org/10.3171/FOC-07/11/E4
Dunville LM, Sood G, Kramer J. Oculocardiac reflex. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [updated 2022 Sep 19 cited 2022 Oct 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499832/.
Mourits MP, van der Sprenkel JW. Orbital meningioma, the Utrecht experience. Orbit. 2001;20(1):25-33. https://doi.org/10.1076/orbi.188.8.131.5240
Wright JE, McNab AA, McDonald WI. Primary optic nerve sheath meningioma. Br J Ophthalmol. 1989;73(12):960-6. https://doi.org/10.1136/bjo.73.12.960
Wright JE, Call NB, Liaricos S. Primary optic nerve meningioma. Br J Ophthalmol. 1980;64(8):553-8. https://doi.org/10.1136/bjo.64.8.553
Solli E, Turbin RE. Primary and secondary optic nerve sheath meningioma. J Neurol Surg B Skull Base. 2021;82(1):27-71.
Kawome MM, Masanganise R. Post-destructive eye surgery, associated depression at Sekuru Kaguvi Hospital Eye Unit, Zimbabwe: pilot study. S Afr Optom. 2013;72(2):71-5. https://doi.org/10.4102/aveh.v72i2.48
Ackuaku-Dogbe EM, Biritwum RB, Briamah ZI. Psycho-social challenges of patients following orbital exenteration. East Afr Med J. 2012;89(12):385-9.
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