1
|
Abstract
A 19-year-old man presented with a 3-year history of episodic headaches, right hemiparesis, and progressive vision loss in both eyes. Initially, extensive laboratory testing was unrevealing. MRI later demonstrated progressive enlargement and enhancement of the left optic nerve poorly correlated with the timing of his clinical manifestations. There was no clinical or radiological response to treatment with corticosteroids, mycophenolate mofetil, or rituximab administered empirically for possible inflammatory processes. Later in the disease course, he developed diabetes insipidus (DI), worsening vision to light perception bilaterally, severe cognitive decline, and spastic quadriparesis. Cerebrospinal fluid (CSF) beta human chorionic gonadotropin (β-hCG) was elevated. Eventually, a left optic nerve biopsy was performed, which was consistent with an intracranial pure germinoma with infiltration of the optic nerve and disseminated leptomeningeal disease. Although rare, intracranial germ cell tumors can primarily involve the anterior visual pathways and should be considered in the setting of DI and elevated CSF β-hCG.
Collapse
|
2
|
Shofty B, Ben Sira L, Constantini S. Neurofibromatosis 1-associated optic pathway gliomas. Childs Nerv Syst 2020; 36:2351-2361. [PMID: 32524182 DOI: 10.1007/s00381-020-04697-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Optic Pathway Gliomas (OPG) are the most common brain tumor in Neurofibromatosis 1 patients (NF1). They are found along the optic pathway and may involve the optic nerves, chiasm, retro-chiasmatic structures, and the optic radiations. NF1 associate OPG (NF1-OPG) have variable presentation, disease course and response to treatment. The optimal management is patient-specific and should be tailored by a multidisciplinary team. Age, sex, histology, and molecular markers may be important factors in the individualized decision-making process. Chemotherapy is the first-line treatment in cases of progressive tumors, and visual preservation is the main goal of treatment. PURPOSE In this paper we will review the disease, practical management, and recent advances of NF1-OPG.
Collapse
Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, Tel Aviv, Israel
| | - Liat Ben Sira
- Pediatric Radiology, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, 6th Weizmann St., 64239, Tel-Aviv, Israel.
| |
Collapse
|
3
|
Dzhindzhikhadze RS, Dreval ON, Lazarev VA, Polyakov AV, Kambiev RL, Salyamova EI. [Cavernous malformation of the optic nerve: clinical case and literature review]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:62-68. [PMID: 32207744 DOI: 10.17116/neiro20208401162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cavernous malformation (cm) of the optic nerve is a rare condition It is clinically presented by the so-called chiasmal apoplexy. Microsurgical removal of cavernous malformation is the method of choice. MATERIAL AND METHODS Authors present a clinical case of the removal of cavernous malformation of the left optic nerve. RESULTS The presented case demonstrates the successful removal of the CM of the left optic nerve from the lateral supraorbital access. In the postoperative period, visual disorders did not worsen. Control MRI of the brain showed total removal of cavernoma. CONCLUSION Presented clinical case demonstrates the radical removal of CM of the optic nerve. Early and correct diagnosis makes it possible to adequately treat the patient and preserve his/her visual functions.
Collapse
Affiliation(s)
- R S Dzhindzhikhadze
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia; F.I. Inozemtsev City Clinical Hospital, Moscow, Russia; M.F. Vladimirsky Moscow Regional Clinical Research Institute, Moscow, Russia
| | - O N Dreval
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - V A Lazarev
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - A V Polyakov
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia; F.I. Inozemtsev City Clinical Hospital, Moscow, Russia
| | - R L Kambiev
- F.I. Inozemtsev City Clinical Hospital, Moscow, Russia
| | - E I Salyamova
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia; F.I. Inozemtsev City Clinical Hospital, Moscow, Russia
| |
Collapse
|
4
|
Sindhuja A, Indiran V, Santhanam R, Maduraimuthu P. Tram-track-like calcification in adult optic pathway glioma. BJR Case Rep 2016; 2:20150378. [PMID: 30459973 PMCID: PMC6243333 DOI: 10.1259/bjrcr.20150378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/10/2016] [Accepted: 02/22/2016] [Indexed: 11/05/2022] Open
Abstract
Gliomas of the optic pathways that occur in adults are rare tumours. The tram-track-like calcification of the optic nerve, which classically occurs with meningioma, has not been reported so far in optic pathway gliomas. Here, we present a case of high-grade glioma of the optic pathway with tram-track-like calcification of the optic nerve in a 42-year-old male. This case enhances our understanding of the MRI features of adult malignant optic pathway glioma.
Collapse
|
5
|
Mahdi Y, Kharmoum J, Alouan A, Elouarradi H, Elkhiyat I, Maher M, Benchrif MZ, Kili A, Daoudi R, Cherradi N. Primary atypical teratoid/rhabdoid tumor of the optic nerve: a rare entity in an exceptional location. Diagn Pathol 2015; 10:47. [PMID: 25934090 PMCID: PMC4416247 DOI: 10.1186/s13000-015-0284-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/22/2015] [Indexed: 11/27/2022] Open
Abstract
Atypical teratoid/rhabdoid tumors are rare and highly malignant central nervous system tumors. They have no specific radiological features and often present several histological components that make a problem in differential diagnosis with medulloblastoma and primitive neuroectodermal tumors. We present the case of a newborn girl complained of a gradual proptosis of the left eye secondary to an expansive lesional process of the optic nerve. The location at the optic nerve, reported only twice in the literature, and an exclusive rhabdoid appearance on biopsy added additional differential diagnosis problems. The proptosis worsened and the infant died few days after two cycles of chemotherapy. VIRTUAL SLIDES The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2037718783145212 .
Collapse
Affiliation(s)
- Youssef Mahdi
- Department of Pathology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
| | - Jinane Kharmoum
- Department of Pathology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
| | - Amal Alouan
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
- Department of Ophtamology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
| | - Hakima Elouarradi
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
- Department of Ophtamology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
| | - Iman Elkhiyat
- Department of Pathology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
| | - Mustapha Maher
- Department of Pathology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
| | - Moulay Zahid Benchrif
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
- Department of Ophtamology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
| | - Amina Kili
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
- Pediatric Hematology and Oncology Center, Ibn Sina University Hospital, Rabat, Morocco.
| | - Rajae Daoudi
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
- Department of Ophtamology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
| | - Nadia Cherradi
- Department of Pathology, Specialities Hospital, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V Souissi University, Rabat, Morocco.
| |
Collapse
|
6
|
Sharma S, Panda A, Jana M, Arora A, Sharma SK. Ophthalmic manifestations of systemic diseases--part 1: phakomatoses, hematologic malignancies, metastases, and histiocytosis. Curr Probl Diagn Radiol 2015; 43:175-85. [PMID: 24948211 DOI: 10.1067/j.cpradiol.2014.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The orbit can be secondarily involved in various systemic conditions. The ophthalmic involvement is often the first clue to the presence of an underlying systemic condition. The ophthalmic involvement in systemic diseases can be either ocular or extraocular. The extent of involvement can be well delineated by imaging modalities like computed tomography and magnetic resonance imaging. In the first part of the article, we provide an overview of systemic diseases affecting the orbit, briefly discuss the modalities for orbital imaging, and discuss the imaging appearances of ophthalmic involvement in (1) phakomatoses, (2) hematologic malignancies, (3) metastases, and (4) histiocytosis. At the end of the 2-part article, we discuss a pattern-based approach and differential diagnosis of orbital lesions in systemic diseases.
Collapse
Affiliation(s)
- Sanjay Sharma
- Department of Radiodiagnosis, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Ananya Panda
- Department of Radiodiagnosis, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Arundeep Arora
- Department of Radiodiagnosis, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shefali K Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Abstract
Optic pathway gliomas (OPGs) are among the most challenging neoplasms in modern pediatric neuro-oncology. Recent technological advances in imaging, surgery, and chemotherapy may lead to better understanding of the pathophysiology and better clinical results. This chapter reviews these advances and the current treatment paradigms.
Collapse
Affiliation(s)
- Ben Shofty
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, 6th Weizmann St., Tel-Aviv, 64239, Israel
| | | | | | | |
Collapse
|
8
|
Derman A, Shields M, Davis A, Knopp E, Fatterpekar GM. Diseases of the Sella and Parasellar Region: An Overview. Semin Roentgenol 2013; 48:35-51. [DOI: 10.1053/j.ro.2012.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
9
|
Liu JK, Lu Y, Raslan AM, Gultekin SH, Delashaw JB. Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature. Neurosurg Focus 2010; 29:E17. [DOI: 10.3171/2010.5.focus10129] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Cavernous malformations (CMs) of the optic pathway and hypothalamus (OPH) are extremely rare. Patients with these lesions typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retroorbital pain, and nausea. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature for reported cases of OPH CMs to analyze clinical and radiographic presentations as well as surgical approaches and neurological outcomes.
Methods
A MEDLINE/PubMed search was performed, revealing 64 cases of OPH CMs. The authors report an additional case in the study, making a total of 65 cases. Each case was analyzed for clinical presentation, lesion location, radiographic features, treatment method, and visual outcome.
Results
In 65 patients with OPH CMs, the optic chiasm was affected in 54 cases, the optic nerve(s) in 35, the optic tract in 13, and the hypothalamus in 5. Loss of visual field and acuity was the most common presenting symptom (98%), followed by headache (60%). The onset of symptoms was acute in 58% of patients, subacute in 15%, and chronic progressive in 26%. Computed tomography scans revealed hyperdense suprasellar lesions, with calcification visible in 56% of cases. Magnetic resonance imaging typically demonstrated a heterogeneous lesion with mixed signal intensities suggestive of blood of different ages. The lesion was often surrounded by a peripheral rim of hypointensity on T2-weighted images in 60% of cases. Minimal or no enhancement occurred after the administration of gadolinium. Hemorrhage was reported in 82% of cases. Most patients were surgically treated (97%) using gross-total resection (60%), subtotal resection (6%), biopsy procedure alone (6%), biopsy procedure with decompression (23%), and biopsy procedure followed by radiation (2%). Those patients who underwent gross-total resection had the highest rate of visual improvement (85%). Two patients were treated conservatively, resulting in complete blindness in 1 patient and spontaneous recovery of vision in the other patient.
Conclusions
Cavernous malformations of the OPH are rare and challenging lesions. Gross-total resection of these lesions is associated with favorable visual outcomes. Emergent surgery is warranted in patients presenting with chiasmal apoplexy to prevent permanent damage to the visual pathway.
Collapse
Affiliation(s)
- James K. Liu
- 1Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey; and Departments of
| | - Yuan Lu
- 1Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey; and Departments of
| | | | | | | |
Collapse
|
10
|
Abstract
Optic pathway gliomas are rare tumors accounting for 3-5% of brain tumors in children; 90% are observed in children. They account for 4% of orbital tumors in children. Association with NF 1 is classical and the incidence of NF 1 in patients with optic pathway gliomas is estimated at 30-58%. Usually these tumors are pilocytic astrocytomas and their regression, particularly in patients with NF 1, has been described. Exophthalmos and loss of visual acuity or blindness are the usualpresentation in progressive disease. CT and above all MRI study of the orbit and the brain are necessary to make a complete evaluation of the disease. Gross total removal of the tumor provides 100% cure, but surgery can be proposed only for growing tumor with severe exophthalmos and no useful field of view or blindness. Chemotherapy must be proposed as first-line treatment for growing tumor with moderate exophthalmos and useful vision when the tumor is strictly confined in the orbit. The place of radiotherapy for pure intraorbital gliomas has not been defined and proton beam therapy has to be evaluated.
Collapse
|
11
|
Value of MR imaging in the differentiation of benign and malignant orbital tumors in adults. Eur Radiol 2010; 20:1692-702. [PMID: 20131055 PMCID: PMC2882044 DOI: 10.1007/s00330-009-1711-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/24/2009] [Accepted: 11/28/2009] [Indexed: 11/16/2022]
Abstract
Purpose To prospectively evaluate magnetic resonance (MR) imaging including dynamic contrast-enhanced MR imaging in the differentiation of benign from malignant orbital masses and to evaluate which MR imaging features are most predictive of malignant tumors. Materials and methods The study was approved by the institutional review board and signed informed consent was obtained. Nonenhanced, static, and dynamic contrast-enhanced MR imaging was performed in 102 adult patients with an orbital mass. Diagnosis was based on histologic findings. MR imaging features of benign and malignant orbital lesions were evaluated correlated with histological findings. Multivariate logistic regression analysis was employed to identify the best combination of MR imaging features that might be predictive of malignancy. Results Nonenhanced, static, and dynamic enhancement MR imaging was significantly superior to two other models in prediction of malignancy (p < 0.05). Multivariate logistic regression analysis identified that the most discriminating MR imaging features were isointense mass on T2-weighted imaging and a washout-type time–intensity curve for both observers. Conclusion Nonenhanced, static, and dynamic enhancement MR imaging improved differentiation between benign and malignant orbital masses in adult patients.
Collapse
|
12
|
|
13
|
Primary, non-exophytic, optic nerve germ cell tumors. J Neurooncol 2009; 95:437-443. [DOI: 10.1007/s11060-009-9941-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 06/15/2009] [Indexed: 11/28/2022]
|
14
|
Lindegaard J, Heegaard S. Tumors of the optic nerve. EXPERT REVIEW OF OPHTHALMOLOGY 2009. [DOI: 10.1586/eop.09.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Abstract
We present a case of glioblastoma multiforme of the optic pathways in a 68 year old lady. Glioblastomas of the optic pathways are rare tumors; the predominant non enhancing component and the vast extent of involvement makes this a unique case. This case report further increases the database of knowledge available on the MRI characteristics of malignant optic glioma of adulthood.
Collapse
Affiliation(s)
- Rahat Brar
- Department of Radiology, Fortis Hospital, Mohali, Punjab, India
| | | | | |
Collapse
|
16
|
Verma A, Morriss C. Atypical teratoid/rhabdoid tumor of the optic nerve. Pediatr Radiol 2008; 38:1117-21. [PMID: 18696060 DOI: 10.1007/s00247-008-0923-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 04/16/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
We report a rare case of atypical teratoid/rhabdoid tumor that presented with imaging findings similar to those of optic pathway glioma. The diagnosis of atypical teratoid/rhabdoid tumor was determined following surgical resection of the tumor by collective histologic and immunohistochemical staining, and cytogenetic analysis. We describe the clinical presentation, neuroimaging findings and pathology, and compare them to those of optic gliomas.
Collapse
Affiliation(s)
- Amit Verma
- Department of Radiology, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, MO, USA.
| | | |
Collapse
|
17
|
Abstract
BACKGROUND Optic gliomas may unpredictably stabilize or progress. Prognosis was known to be better in patients with neurofibromatosis 1 (NF1) than those with non-NF1. The confusion over management is caused, at least in part, by the uncertain disease course of the tumor. CASE HISTORY We report here a 13-year-old girl presented with a 1-month history of a gradual decline of vision in her left eye. She was diagnosed by clinical examination and magnetic resonance imaging as having a left optic-nerve glioma and was followed by serial magnetic resonance imaging over 3 years. She and her family did not show any stigmata of NF1. Approximately 3 years after the onset of her symptoms, visual acuity, color testing, and visual fields have markedly improved with tumor regression by magnetic resonance imaging. CONCLUSIONS The possibility of spontaneous regression of an optic-nerve glioma should be considered even in the planning of treatment for a non-NF1 patient with this tumor.
Collapse
Affiliation(s)
- Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
| | | | | |
Collapse
|
18
|
Abstract
Orbital tumours are lesions that appear within the orbital craniofacial borders. To this end, treatment of these tumours is assured by teams of different specialists. Furthermore, these pathologies are different in adults and in children. We have endeavoured, in this chapter, to highlight the specifically neurosurgical features of orbital tumours or, to be more precise, tumours affecting the posterior two thirds of the orbit and tumours originating in or intruding into the optic canal. The list of aetiologies is long. After recapitulating the main types of tumour (as well as those of most concern), we have also studied the different stages of surgery, namely approaches and reconstructions which we have illustrated at each stage by a tumour that, in our view, seemed emblematic of the problem in question: the lateral eyebrow approach for schwannoma and cavernous angioma, the transorbital subfrontal approach for optic nerve glioma, the pterional and orbital approaches for spheno-orbital meningioma, problems with reconstruction and with plexiform neurofibroma affecting the orbit and fibrous dysplasia of bone.
Collapse
Affiliation(s)
- J C Marchal
- Department of Neurosurgery, Hôpital Central, Nancy University Hospital, France
| | | |
Collapse
|
19
|
Koeller KK, Rushing EJ. From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation. Radiographics 2005; 24:1693-708. [PMID: 15537977 DOI: 10.1148/rg.246045146] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pilocytic astrocytoma is the most common pediatric central nervous system glial neoplasm and the most common pediatric cerebellar tumor. This tumor has a noteworthy benign biologic behavior that translates into an extremely high survival rate-94% at 10 years-that is by far the best of any glial tumor. Most patients present in the first 2 decades, and clinical symptoms and signs are usually of several months duration and directly related to the specific location of the tumor. The cerebellum, optic nerve and chiasm, and hypothalamic region are the most common locations, but the tumor can also be found in the cerebral hemisphere, ventricles, and spinal cord. Surgical resection is the treatment of choice for all tumors, except for those involving the optic pathway and hypothalamic region, which may be treated with radiation therapy and chemotherapy. Cross-sectional imaging often demonstrates a classic appearance: a cystic mass with an enhancing mural nodule. Less common appearances are quite nonspecific. Surrounding vasogenic edema is rarely present, and this feature provides a valuable clue to the correct diagnosis. Accurate interpretation of imaging studies plays an essential role in directing treatment of these tumors, particularly when they arise in the optic pathway of patients with neurofibromatosis type 1. Disseminated disease and recurrence are extremely rare.
Collapse
Affiliation(s)
- Kelly K Koeller
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th St at Alaska Ave, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA.
| | | |
Collapse
|
20
|
Pungavkar SA, Lawande MA, Patkar DP, Agrawal NV, Gadani S. Bilateral optic pathway glioma with intracranial calcification: Magnetic resonance imaging and magnetic resonance spectroscopy findings. ACTA ACUST UNITED AC 2005; 49:489-92. [PMID: 16351614 DOI: 10.1111/j.1440-1673.2005.01442.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Optic nerve glioma is the most common primary neoplasm of the optic nerve in childhood. It can extend intracranially along the optic pathway (optic pathway glioma). The lesion tends to present with decreased visual acuity in the affected eye, but can cause additional symptoms when it is large. Local involvement within the orbit can be characterized using CT, but MRI is superior in showing the intracranial extent of the lesion. Intracranial calcification in optic pathway glioma is rare. We present a rare case of optic pathway glioma with calcification in the intracranial component. Also, we describe MR spectroscopy (MRS) findings in this case.
Collapse
Affiliation(s)
- S A Pungavkar
- MRI Department, Dr Balabhai Nanavati Hospital and Research Centre, S.V. Road, Vileparle (West), Mumbai 400 056, India
| | | | | | | | | |
Collapse
|
21
|
Weber AL, Caruso P, Sabates NR. The optic nerve: radiologic, clinical, and pathologic evaluation. Neuroimaging Clin N Am 2005; 15:175-201. [PMID: 15927867 DOI: 10.1016/j.nic.2005.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The radiologic investigation of the optic nerve plays an integral part in the diagnostic evaluation of diverse lesions of the optic pathways including inflammatory diseases, vascular disorders and benign and malignant tumors and these radiologic modalities consist principally of CT and MR imaging and, in vascular lesions, MR angiography and conventional angiography. The selection of radiologic studies and their focus is based on the ophthalmologic examination where the ophthalmologist can often determine the suspected location of lesions in the anterior or posterior visual pathways. Furthermore, inspection of the eye, including adnexal structures and funduscopy, provides additional information in the clinical assessment of these patients. With technical advances in the last few years, CT and MR imaging can detect lesions and determine their location and extent with high sensitivity and specificity. This article discusses the radiologic, clinical, and pathologic evaluation of the optic nerve.
Collapse
Affiliation(s)
- Alfred L Weber
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | | | | |
Collapse
|
22
|
Aviv RI, Miszkiel K. Orbital imaging: Part 2. Intraorbital pathology. Clin Radiol 2005; 60:288-307. [PMID: 15710134 DOI: 10.1016/j.crad.2004.05.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 02/18/2004] [Accepted: 05/05/2004] [Indexed: 11/25/2022]
Abstract
Several primary and secondary processes may affect the orbit. We present a review of intraorbital pathology utilising a compartmental approach guiding the differential diagnosis. Knowledge of the contents of each compartment facilitates the differential diagnosis. Globe pathology is not dealt with in this review.
Collapse
Affiliation(s)
- R I Aviv
- Department of Neuroradiology, Sunnybrook and Women's College Hospital, Toronto, Canada.
| | | |
Collapse
|
23
|
Jäger HR. Loss of vision: imaging the visual pathways. Eur Radiol 2005; 15:501-10. [PMID: 15672276 DOI: 10.1007/s00330-004-2638-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 12/16/2004] [Accepted: 12/17/2004] [Indexed: 10/25/2022]
Abstract
This is an overview of diseases presenting with visual impairment, which aims to provide an understanding of the anatomy and pathology of the visual pathways. It discusses the relevant clinical background and neuroimaging findings on CT and standard and advanced MRI of diseases affecting the globe; optic nerve/sheath complex; optic chiasm, tract and radiation; and visual cortex. The overview covers common tumours, trauma, inflammatory and vascular pathology, and conditions such as benign intracranial hypertension and posterior reversible leukoencephalopathy syndrome.
Collapse
Affiliation(s)
- H R Jäger
- Lysholm Department of Neuroradiology, Institute of Neurology, 9-11 Queen Square, London, WC1N 3BG, UK.
| |
Collapse
|
24
|
Abstract
Intracranial pathologies involving the visual pathway are manifold. Aligning to anatomy, the most frequent and/or most important extrinsic and intrinsic intracranial lesions are presented. Clinical symptoms and imaging characteristics of lesions of the sellar region are demonstrated in different imaging modalities. The extrinsic lesions mainly consist of pituitary adenomas, meningeomas, craniopharyngeomas and chordomas. In (asymptomatic and symptomatic) aneurysms, different neurological symptoms depend on the location of aneurysms of the circle of Willis. Intrinsic tumors as astrocytoma of any grade, ependymoma and primary CNS-lymphoma require the main pathology in the course of the visual pathway. Vascular and demyelinating diseases complete this overview of intracranial lesions.
Collapse
Affiliation(s)
- W Müller-Forell
- Institute of Neuroradiology, Medical School University of Mainz, Langenbeckstrasse 1, D-55101, Mainz, Germany.
| |
Collapse
|
25
|
Abstract
This overview of orbital pathology deals with different kinds of tumors, inflammatory, vascular, and traumatic diseases, which may involve the orbit. Depending on the respective orbital compartment of the globe, the intrakonal, extrakonal and optic nerve the most important and most frequent lesions are presented with their specific clinical symptoms. Their specific presentation on CT- and MR-imaging is discussed in detail, including the most important differential diagnosis.
Collapse
Affiliation(s)
- W Müller-Forell
- Institute of Neuroradiology, Medical School University of Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany.
| | | |
Collapse
|
26
|
Gorospe L, Royo A, Berrocal T, García-Raya P, Moreno P, Abelairas J. Imaging of orbital disorders in pediatric patients. Eur Radiol 2003; 13:2012-26. [PMID: 12942303 DOI: 10.1007/s00330-002-1738-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2002] [Revised: 07/24/2002] [Accepted: 10/01/2002] [Indexed: 10/26/2022]
Abstract
The spectrum of orbital lesions occurring in childhood is wide, including a variety of both benign and malignant disorders. Although physical examination and fundoscopy may aid in establishing the diagnosis of retro-ocular lesions, imaging remains a critical step in the evaluation of the pediatric orbit. Ultrasonography, CT, and MR imaging are the primary modalities for the evaluation of the diseased orbit, and careful observation of the characteristic radiological features usually leads to correct diagnosis; however, some of the lesions look very similar and are difficult to differentiate from each other. The purpose of this article is to review the common and unusual entities that may involve the pediatric orbit, to describe the radiological features, and to evaluate the efficacy of US, CT, and MRI in the diagnosis and management of these conditions.
Collapse
Affiliation(s)
- Luis Gorospe
- Department of Radiology, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
27
|
Shen TT, Sakai O, Curtin HD, Rizzo JF. Magnetic resonance imaging of primary anterior visual pathway tumors. Int Ophthalmol Clin 2001; 41:171-80. [PMID: 11198144 DOI: 10.1097/00004397-200101000-00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- T T Shen
- Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | | | | | | |
Collapse
|