Clinical presentation: A 38 year old woman comes with complaints on right eye ptsosis and mild blurring of vision.
Description:
A T2 hyperintense intra-conal mass, which shows homogenous post contrast enhancement encases the right optic nerve.
Posteriorly, tumor is extending along the optic nerve through the optic canal.
There is mild proptosis on the right side.
Pathology:
Optic nerve meningiomas arise from the arachnoid cap cells of the optic nerve sheath.
Typically has a smooth or lobulated contour.
The optic nerve, which is usually circumferentially encased, gradually atrophies due to compression.
Treatment:
Treatment depends on the degree of visual impairment and proptosis.
In patients with preserved vision and no proptosis, conservative management with frequent ophthalmologic and radiological follow-up is usually preferred.
When vision begins to fail surgical intervention is tempting but often of limited success as far as preserving vision is concerned.
Fenestration of the dural sheath has been tried but is of no benefit.
Differentials:
Major differentials would be:
ON glioma
Lymphoma
Pseudotumor
Metastases
Image on the right shows an optic nerve glioma which shows expansion of the nerve. Unlike in meningioma where the nerve was encased by the tumor.
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