PubMed · 6729495
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L B Staubach. 1984. Enlarged optic nerve.. https://doi.org/10.1016/0037-198x(84)90027-0
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BACKGROUND: The optic nerve sheath meningioma usually presents with a diffuse atrophy of the disc and a diffuse depression of the visual field. Applying this rule too rigidly can lead to a false diagnosis. PATIENT: A 45y-old-woman presented with atrophy of the upper disc and a corresponding altitudinal field defect in her right eye. AION was diagnosed. Seventeen years later the patient returned with an exophthalmus. The disc was atrophic and a shunt vessel connected the central retinal vein with the choroid. CT revealed an orbital mass. The diagnosis of an optic nerve sheath meningioma was made and confirmed at surgery. DISCUSSION: The meningioma may have occluded an upper posterior ciliary artery, mimiking an AION. Alternatively, the meningioma may have destroyed the fibers running through the upper half of the disc and caused swelling of the remaining fibers in the lower half of the disc. CONCLUSION: In the combination of swelling and atrophy of one disc an optic nerve sheath meningioma should be considered, even if the two components are located in different sectors. In optic nerve sheath meningioma vision decreases insidiously as opposed to the acute drop typical for anterior ischemic optic atrophy.
A case of facial nerve neurilemmoma within the temporal bone is reported. The patient is a 47-year-old female complaining of 10 years' history of left facial palsy. CT and MRI examinations showed an enlarged mass of the tympanic cavity protruding into the petrous bone, mastoid cavity and external auditory meatus. An open biopsy of the tumor at the external auditory meatus revealed neurilemmoma. The tumor was totally removed by a retroauricular approach. Five months after surgery, both the cross nerve graft using the peroneal nerve and the temporal muscle transfer, method modified by Johnson were performed for the functional recovery of facial palsy.
Primary malignant melanoma of the optic nerve head is an extremely rare tumor. We describe a patient with a pigmented optic nerve lesion that simulated a growing melanocytoma. The pigmented tumor slowly infiltrated the optic nerve causing disc edema, retinal venous congestion, progressive visual field loss, and eventually, loss of central acuity. Following enucleation of the eye, and later resections of the optic nerve to the chiasm, histopathologic examination of the optic nerve, disc, and peripapillary region demonstrated a primary malignant melanoma of the optic nerve without choroidal involvement. Involvement of the optic nerve extended 26 mm beyond the lamina cribrosa. Malignant melanoma of the optic nerve is a real entity and may clinically simulate a melanocytoma.