1
|
Yamashiro K, Sadato A, Hirose Y. A Patient With Exophytic Primary Optic Nerve Sheath Meningioma: Stratified Risk of Surgery Based on the Morphology. J Craniofac Surg 2023; Publish Ahead of Print:00001665-990000000-00713. [PMID: 37220669 DOI: 10.1097/scs.0000000000009366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 05/25/2023] Open
Abstract
Primary optic nerve sheath meningioma (pONSM) is one of the most challenging tumors to manage. Although surgical excision may be considered a treatment option to maintain visual function, the safety of surgery remains debatable due to the non-negligible risk of optic nerve injury. pONSM often grows concentrically around the optic nerve; however, it can also demonstrate an exophytic growth from the optic nerve. The risk of surgical excision of pONSM may vary based on the tumor's growth pattern and area of contact with the optic nerve; however, there has been no detailed report on risk stratification to date. The authors present an illustrative case of an exophytic pONSM which was removed surgically without complications, suggesting that tumor morphology may also influence the surgical risk. In this report, the imaging and intraoperative features of exophytic pONSM are presented in detail, and the risk factors for complications are discussed.
Collapse
Affiliation(s)
- Kei Yamashiro
- Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki Aich, Japan
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| |
Collapse
|
2
|
Buelens T, Scifo L, Valyi Z, Willermain F. Sarcoidosis revealed by simultaneous optic nerve and eyelid involvement: A case report. Am J Ophthalmol Case Rep 2022; 26:101451. [PMID: 35252626 PMCID: PMC8889372 DOI: 10.1016/j.ajoc.2022.101451] [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: 09/10/2021] [Revised: 02/11/2022] [Accepted: 02/20/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Ocular disease can be the initial manifestation in patients with sarcoidosis. It is most often associated with uveitis, but eyelid or optic nerve disease can also be presenting features. Although uncommon and easy to overlook in a patient presenting with visual loss, paying attention to the presence of eyelid granulomas in our patient proved to be very helpful in our diagnostic work up for optic neuropathy. Observations A young otherwise healthy patient was addressed with a 3 month history of bilateral painless visual loss. At presentation, best-corrected visual acuity was counting fingers in both eyes. Anterior segment slit-lamp examination was completely normal in both eyes. Eye fundus examination revealed subtle optic disc swelling in the left eye. Interestingly, flesh-colored nodular eyelid lesions were found bilaterally. Basic work-up for optic neuropathy showed elevated levels of serum lysozyme and serum angiotensin converting enzyme. More importantly, a biopsy specimen of an eyelid nodule demonstrated multiple non-necrotizing granulomas, a hallmark sign of sarcoidosis. Despite a delay in treatment of several months after onset of symptoms, response to systemic corticosteroids was prompt and important with visual acuity improving to 20/20 in both eyes as well as complete resorption of all eyelid lesions. Conclusion and importance In the diagnostic work-up for optic neuropathy, the answer can sometimes be hiding where it's least expected: the possible presence of eyelid lesions should not be overlooked as they may orient us towards sarcoidosis as an underlying etiology.
Collapse
|
3
|
Takahashi Y, Kono S, Vaidya A, Kakizaki H. Optic Neuropathy Caused by a Perineural Sarcoid Lesion. Cureus 2022; 14:e21966. [PMID: 35282525 PMCID: PMC8906538 DOI: 10.7759/cureus.21966] [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] [Accepted: 02/06/2022] [Indexed: 11/13/2022] Open
Abstract
A 74-year-old woman had a six-month history of decreased vision in the left eye. On the first examination, her left best-corrected visual acuity was 0.02, and Goldmann visual field test revealed a central scotoma in the left eye. Magnetic resonance imaging demonstrated lesions around the optic nerve on both sides and enlargement of the lacrimal gland and superior rectus/levator palpebrae superioris muscles on both sides and the medial and inferior recti muscles on the left side. Systemic computed tomography revealed bilaterally enlarged mediastinal and supraclavicular lymph nodes. The blood test results included an elevated soluble interleukin-2 receptor. Pathological examination of the specimens harvested from the lacrimal gland on both sides, left levator palpebrae superioris muscle, and the lesion around the optic nerve on the left side showed lymphocytic infiltration with noncaseating epithelioid granuloma. After the biopsy, the patient underwent two cycles of steroid pulse therapy, followed by oral prednisolone. Although the lesions were reduced after steroid treatment, the left vision did not recover.
Collapse
|
4
|
Optic Neuropathy of Inflammation and Infiltration. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
5
|
Abstract
BACKGROUND Sarcoidosis is an idiopathic, multisystem, inflammatory disease that has central nervous system involvement in 5%-15% of cases. The presentation of neurosarcoidosis is highly variable, and the MRI findings often mimic the appearance of other central nervous system diseases. Therefore, the diagnosis can be challenging. About one-third of neurosarcoidosis cases have neuro-ophthalmic manifestations and, thus, may be evaluated by a neuro-ophthalmologist early in the disease course. METHODS We performed a retrospective review of 22 cases of biopsy-proven sarcoidosis with neuro-ophthalmic manifestations, seen at the Wilmer Eye Institute from January 2013 to September 2019, in which we described the demographic information, clinical presentations, neuroimaging findings, and diagnostic evaluations. RESULTS Twenty-two patients were included. Fifteen patients identified as black and 7 as white. Fifteen were women, and 7 men. Mean age at sarcoidosis diagnosis was 45.9 years (range 26-66). Neuro-ophthalmic findings included optic neuropathy in 11 (50%); proptosis/orbital inflammation in 5 (23%); abducens palsy in 5 (23%); trochlear palsy, trigeminal distribution numbness, and bitemporal hemianopia in 2 each (9%); and oculomotor palsy, facial palsy, optic perineuritis, dorsal midbrain syndrome, central vestibular nystagmus, and papilledema in 1 each (5%). Eight (36%) had a pre-existing diagnosis of sarcoidosis; however, in 14 (64%), the neuro-ophthalmic presentation led to the sarcoidosis diagnosis. Patients with a pre-existing sarcoidosis diagnosis were younger than those without this diagnosis (38.5 vs 50.1 years, P = 0.035). Brain MRI was abnormal in all but 1 case (95%). In patients without a pre-existing sarcoidosis diagnosis, all 7 tested for angiotensin converting enzyme (ACE) had normal values, and 75% of the 12 who had computed tomography (CT) chest had findings suggestive of sarcoidosis (86% of black patients vs 50% of white patients). CONCLUSIONS Patients with neurosarcoidosis may present initially with a neuro-ophthalmic manifestation, and this presentation may be more common in older patients. MRI usually is abnormal, although findings may be nonspecific. Serum testing for ACE is not helpful. Normal CT chest does not rule out underlying sarcoidosis, particularly in white patients.
Collapse
|
6
|
Armstrong JJ, Zhang R, Fung M, Zeman-Pocrnich C, Rotenberg B, Bauman G, Gilbert K, Hutnik CM. Rapid visual field progression in a patient with glaucoma as the presenting manifestation of sarcoidosis. Am J Ophthalmol Case Rep 2021; 23:101132. [PMID: 34151046 PMCID: PMC8192818 DOI: 10.1016/j.ajoc.2021.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report a case of accelerated visual field progression secondary to a new orbital apex lesion in a patient with a longstanding history of fatigue and cough. OBSERVATIONS A 73-year-old myopic female with known open angle glaucoma presented with accelerated unilateral visual field progression. Maximally tolerated medical therapy was instituted over a period of 1-2 years with imminent discussions of surgical intervention. Around this time the patient reported worsening cough and fatigue, which were initially attributed to glaucoma medication side effects. Consideration of the patient's remote history of melanoma and the current asymmetry of the visual field progression triggered a computerized tomography (CT) scan of the orbits as part of the management. An orbital apex lesion was discovered, raising suspicion for metastatic melanoma, and restaging CT imaging uncovered renal, hepatic, and mediastinal masses. Unexpectedly, biopsies revealed non-necrotizing granulomatous inflammatory processes consistent with a diagnosis of sarcoidosis. It is perhaps noteworthy that the patient had received interferon therapy for management of her melanoma; previous reports have associated interferon exposure with subsequent sarcoid disease, regardless of duration of therapy or elapsed time since exposure. CONCLUSIONS AND IMPORTANCE Although rare, sarcoidosis can occur virtually anywhere in the body, including the orbital apex. Its common early symptoms, fatigue and cough, are insidious and seen frequently in this patient's age group and medication side effect profile. It is important to maintain an appropriate index of suspicion when monitoring atypical visual field progression in a patient with glaucoma. In this case, imaging, subsequent biopsy, and a multi-specialty team were integral to this patient's diagnosis and management.
Collapse
Affiliation(s)
- James J. Armstrong
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Richard Zhang
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew Fung
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Cady Zeman-Pocrnich
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Brian Rotenberg
- Department of Otolaryngology – Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Glenn Bauman
- Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kenneth Gilbert
- Division of General Internal Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Cindy M.L. Hutnik
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Ivey Eye Institute, St. Joseph's Hospital, London, Ontario, Canada
| |
Collapse
|
7
|
Solli E, Turbin RE. Primary and Secondary Optic Nerve Sheath Meningioma. J Neurol Surg B Skull Base 2021; 82:27-71. [PMID: 33777618 DOI: 10.1055/s-0041-1723801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective This study was aimed to review issues relating to the recognition, radiographic diagnosis, monitoring, and management of primary and secondary optic nerve sheath meningioma (ONSM). Design This study is a review of peer-reviewed literature combined with illustrative case studies. Participants and Methods A literature search was conducted via the PubMed database using pertinent search terms. Selected articles were limited to those written or translated into English. Additional works cited within articles were also included. Individual cases were drawn from the experience of a tertiary academic neuroophthalmic and orbital practice. Tables summarize radiotherapeutic and surgical studies, excluding single case reports and studies focusing on meningioma of intracranial origin. Main Outcome Measurements Review of reported surgical and radiotherapeutic series is the primary measurement. Results The natural history of optic nerve sheath meningiomas is primarily characterized by progressive ipsilateral vision loss. Diagnosis is typically based on radiographic imaging findings, with biopsy remaining indicated in some patients. Management strategies may include observation, radiation, and/or surgical intervention, or a combination of these approaches. The role of surgery, especially with respect to primary ONSM (pONSM), remains controversial. Advancement of radiotherapy techniques has shifted modern treatment paradigms in pONSM toward radiation as primary treatment, as surgical outcomes are inferior in major studies. Although radiation remains the treatment of choice in many cases, selected patients may benefit from surgery, especially in the setting of secondary ONSM (sONSM). Conclusion A wide variety of radiotherapeutic and surgical treatment modalities for ONSM exist. The specific indications for each management strategy continue to be redefined.
Collapse
Affiliation(s)
- Elena Solli
- Icahn School of Medicine at Mount Sinai, New York, New York, United States.,Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Roger E Turbin
- Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| |
Collapse
|
8
|
Abstract
OBJECTIVE To describe the ocular findings of neurosarcoidosis (NS) through a case series and review the current literature on the ocular complications of NS. METHODS Case series of 4 patients with a literature review. RESULTS Ophthalmic involvement in NS includes scleritis, cranial nerve palsies, uveitis, optic nerve granulomas, and occlusive retinal vasculitis. CONCLUSION NS is an uncommon, but potentially life-threatening, manifestation of sarcoidosis with ocular involvement up to 25% of patients. Patients presenting with neuro-ophthalmic manifestations of sarcoidosis are more likely to have other sites of involvement requiring ophthalmologists to maintain a high index of suspicion for systemic disease.
Collapse
|
9
|
Sève P, Jamilloux Y, Tilikete C, Gerfaud-Valentin M, Kodjikian L, El Jammal T. Ocular Sarcoidosis. Semin Respir Crit Care Med 2020; 41:673-688. [PMID: 32777852 DOI: 10.1055/s-0040-1710536] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.
Collapse
Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France.,Hospices Civils de Lyon, Pôle IMER, Lyon, France.,University Claude Bernard-Lyon 1, HESPER EA 7425, Univ. Lyon, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Caroline Tilikete
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Laurent Kodjikian
- Neurology D and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.,Université de Lyon, Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028 CNRS UMR5292, Team ImpAct, Bron, France.,Department of Ophthalmology, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| | - Thomas El Jammal
- Department of Internal Medicine, Hopital de la Croix-Rousse, Université Claude Bernard Lyon I, Lyon, France
| |
Collapse
|
10
|
|
11
|
Campagna G, Prospero Ponce CM, Vickers A, Hong BYB, Pellegrini F, Cirone D, Romano F, Machin P, Lee AG. Neuro-Ophthalmic Sarcoidosis. Neuroophthalmology 2019; 44:319-326. [PMID: 33012922 DOI: 10.1080/01658107.2019.1583761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background: In the absence of confirmatory biopsy, the criteria for diagnosis of neuro-ophthalmic sarcoidosis are not well established. Diagnostic criteria for both intraocular sarcoidosis and neurosarcoidosis have been proposed, but the diagnosis of neuro-ophthalmic sarcoidosis remains challenging. It is our intention to augment what is currently known about the diagnosis of neuro-ophthalmic sarcoidosis by providing a series of biopsy-proven cases that contribute to the continued development of diagnostic criteria for this enigmatic condition. Methods: Case series of four Caucasian women with biopsy-proven neuro-ophthalmic sarcoidosis. Results: The first patient was initially diagnosed with traumatic optic neuropathy following a fall. Years later, the presence of pathologic submandibular lymphadenopathy was identified and biopsied, revealing non-caseating granulomas. The second and third cases involved sarcoidosis of the extraocular muscles without clear or common systemic features of sarcoidosis. In the fourth and final case, the patient presented with a Horner syndrome attributed to sarcoid infiltration of the ipsilateral sympathetic chain. Bronchoscopy with biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions: We describe four cases of neuro-ophthalmic sarcoidosis and propose possible neuro-orbital and neuro-ophthalmic criteria both with and without diagnostic biopsy.
Collapse
Affiliation(s)
| | - Claudia M Prospero Ponce
- Department of Pathology and Genomic Medicine, Ocular Pathology, Houston Methodist Hospital, Houston, Texas, USA
| | - Aroucha Vickers
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Bennett Yau-Bun Hong
- Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Francesco Pellegrini
- Neuro-Ophthalmology Service, Department of Ophthalmology, De Gironcoli Hospital, Conegliano, Italy
| | - Daniele Cirone
- Uveitis Service, Department of Ophthalmology, Clinica Villa Anna, San Benedetto del Tronto, Italy
| | - Francesco Romano
- Neuro-Ophthalmology Service, Department of Ophthalmology, De Gironcoli Hospital, Conegliano, Italy
| | | | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.,Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch, Galveston, Texas, USA.,Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York City, New York, USA.,Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
12
|
Serova NK, Shkarubo AN, Tropinskaya OF, Eliseeva NM, Shishkina LV. [Neurosarcoidosis of the anterior visual pathway (a case report and literature review)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:97-103. [PMID: 31577275 DOI: 10.17116/neiro20198304197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown nature. Patients often present with pulmonary, skin, eye, and orbital lesions. Involvement of the central nervous system (CNS) is accompanied by granulomatous leptomeningitis and damage to the basal brain structures with formation of granulomas near the cranial nerves, hypothalamus, pituitary gland, cavernous sinuses, optic chiasm, and intracranial optic nerves. The optic nerves can be affected independently of the other CNS regions, which may be the first manifestation of the disease. The article presents two clinical cases of sarcoidosis affecting the anterior visual pathway. Diagnosis of the disease was associated with certain difficulties. A biopsy revealed a sarcoidosis lesion.
Collapse
Affiliation(s)
- N K Serova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | | |
Collapse
|
13
|
Kefella H, Luther D, Hainline C. Ophthalmic and neuro-ophthalmic manifestations of sarcoidosis. Curr Opin Ophthalmol 2017; 28:587-594. [PMID: 28759560 DOI: 10.1097/icu.0000000000000415] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Sarcoidosis is a multisystemic inflammatory disease that commonly affects the eye and less often the neuro-ophthalmic pathways. The manifestations can be quite variable but can have characteristic signs and clinical features. This review provides a comprehensive overview of the various ocular and neuro-ophthalmic manifestations of sarcoidosis, emerging diagnostic measures and approach to treatment. Particular focus is given to recent advances in diagnostic approach and available treatment options. RECENT FINDINGS Laboratory investigations, chest and nuclear medicine imaging remain important techniques for helping to diagnose sarcoidosis. Recent evidence suggests a role for aqueous humor analysis in the diagnosis of ocular sarcoidosis. Characteristic neuroimaging may help differentiate neurosarcoidosis from other causes. The role of blind conjunctival biopsy for suspected neurosarcoidosis is discussed. The emerging role and use of biologics is delineated for the treatment of both ocular and neuro-ophthalmic sarcoidosis. SUMMARY Sarcoidosis can affect any part of the visual system: the most common ocular manifestation is uveitis and the most common neuro-ophthalmic manifestation is optic neuropathy. Although diagnosis remains challenging, recent advancements in diagnosis are promising. Emerging biologics with particular efficacy for ocular and neuro-ophthalmic disease provide expanding treatment options for sight-threatening disease.
Collapse
Affiliation(s)
- Haben Kefella
- aDepartment of Ophthalmology bDepartment of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | | |
Collapse
|
14
|
Kidd DP, Burton BJ, Graham EM, Plant GT. Optic neuropathy associated with systemic sarcoidosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e270. [PMID: 27536707 PMCID: PMC4972000 DOI: 10.1212/nxi.0000000000000270] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/27/2016] [Indexed: 11/15/2022]
Abstract
Objective: To identify and follow a series of 52 patients with optic neuropathy related to sarcoidosis. Methods: Prospective observational cohort study. Results: The disorder was more common in women and affected a wide age range. It was proportionately more common in African and Caribbean ethnic groups. Two clinical subtypes were identified: the more common was a subacute optic neuropathy resembling optic neuritis; a more slowly progressive optic neuropathy arose in the remaining 17%. Sixteen (31%) were bilateral. Concurrent intraocular inflammation was seen in 36%. Pain arose in only 27% of cases. An optic perineuritis was seen in 2 cases, and predominate involvement of the chiasm in one. MRI findings showed optic nerve involvement in 75% of cases, with adjacent and more widespread inflammation in 31%. Treatment with corticosteroids was helpful in those with an inflammatory optic neuropathy, but not those with mass lesions. Relapse of visual signs arose in 25% of cases, necessitating an increase or escalation of treatment, but relapse was not a poor prognostic factor. Conclusions: This is a large prospective study of the clinical characteristics and outcome of treatment in optic neuropathy associated with sarcoidosis. Patients who experience an inflammatory optic neuropathy respond to treatment but may relapse. Those with infiltrative or progressive optic neuropathies improve less well even though the inflammatory disorder responds to therapy.
Collapse
Affiliation(s)
- Desmond P Kidd
- Departments of Neuro-ophthalmology (D.P.K., B.J.B., E.M.G., G.T.P.), the National Hospital for Neurology and Neurosurgery, The Royal Free Hospital, St Thomas' Hospital, London; James Paget University Hospital (B.J.B.), Great Yarmouth; and University of East Anglia (B.J.B.), Norwich, UK
| | - Ben J Burton
- Departments of Neuro-ophthalmology (D.P.K., B.J.B., E.M.G., G.T.P.), the National Hospital for Neurology and Neurosurgery, The Royal Free Hospital, St Thomas' Hospital, London; James Paget University Hospital (B.J.B.), Great Yarmouth; and University of East Anglia (B.J.B.), Norwich, UK
| | - Elizabeth M Graham
- Departments of Neuro-ophthalmology (D.P.K., B.J.B., E.M.G., G.T.P.), the National Hospital for Neurology and Neurosurgery, The Royal Free Hospital, St Thomas' Hospital, London; James Paget University Hospital (B.J.B.), Great Yarmouth; and University of East Anglia (B.J.B.), Norwich, UK
| | - Gordon T Plant
- Departments of Neuro-ophthalmology (D.P.K., B.J.B., E.M.G., G.T.P.), the National Hospital for Neurology and Neurosurgery, The Royal Free Hospital, St Thomas' Hospital, London; James Paget University Hospital (B.J.B.), Great Yarmouth; and University of East Anglia (B.J.B.), Norwich, UK
| |
Collapse
|
15
|
Ganesh SK, Kaduskar AV. Optic nerve head granuloma as a primary manifestation of ocular sarcoidosis - A tertiary uveitis clinic experience. Oman J Ophthalmol 2016; 8:157-61. [PMID: 26903720 PMCID: PMC4738659 DOI: 10.4103/0974-620x.169890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To report a case series of ocular sarcoidosis manifesting as optic nerve head granuloma. Design: Observational case series. Results: Unilateral presentation in three females and a male. None of them had symptoms suggestive of systemic involvement. Fundus examination in all the patients showed hyperemic optic discs with peripapillary subretinal granuloma. Serum angiotensin converting enzyme was elevated in all patients. Chest radiograph was within normal limits in all patients. High resolution computed tomography of the chest showed features of sarcoidosis in two patients. All patients were treated with oral steroids. Immunosupressants were given in three patients, intravenous steroid, followed by oral steroids given in three patients. Improvement in visual acuity was noted in all four patients. Conclusion: Primary optic nerve involvement in sarcoidosis is rare. Isolated optic nerve sarcoidosis may exist without any systemic manifestations. Corticosteroids with immunosuppressants form the mainstay of therapy.
Collapse
Affiliation(s)
- Sudha K Ganesh
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anushree Vijay Kaduskar
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
16
|
|
17
|
|
18
|
Khong JJ, McNab AA. Medial transconjunctival intrinsic optic nerve biopsy: surgical technique and indications. Orbit 2012; 31:227-232. [PMID: 22631221 DOI: 10.3109/01676830.2012.669010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To describe a method of intrinsic optic nerve biopsy and its indications. METHODS Retrospective case series. RESULTS We report four cases that required intrinsic optic nerve biopsy for progressive optic neuropathy with uncertain diagnosis after negative systemic investigations. In all cases, a medial transconjunctival approach was used. There were no complications noted with this technique in the series, specifically there was no reported deterioration in vision. One case of neurosarcoidosis was confirmed. In the other three cases, the pathology results were non-diagnostic but ruled out serious causes such as central nervous system leukaemia relapse. CONCLUSION Medial transconjunctival intrinsic optic nerve biopsy is a minimally invasive and safe technique. The technique is suitable for sampling pathology in the distal portion of the optic nerve. Optic nerve biopsy is indicated when there is significant loss of vision from an isolated optic nerve disease and all systemic investigations have failed to identify the cause, or where the clinical course of a presumed diagnosis is atypical.
Collapse
Affiliation(s)
- Jwu Jin Khong
- The Royal Victorian Eye and Ear Hospital, Orbital Plastics and Lacrimal Unit, Melbourne, Australia.
| | | |
Collapse
|
19
|
Progressive bilateral visual and hearing loss in an elderly woman. J Neuroophthalmol 2010; 30:372-5. [PMID: 21107125 DOI: 10.1097/wno.0b013e3181f50ba2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Valero-González S, Díaz-Vega B, Saucedo-Díaz G, Yebra-Bango M. Neurosarcoidosis aislada del nervio óptico. Med Clin (Barc) 2010; 135:137-8. [DOI: 10.1016/j.medcli.2009.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 04/16/2009] [Indexed: 11/28/2022]
|
21
|
Lee AG. Optic atrophy: a diagnostic sign but not a diagnosis. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.13] [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]
|
22
|
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]
|
23
|
Harold Lee HB, Garrity JA, Cameron JD, Strianese D, Bonavolontà G, Patrinely JR. Primary Optic Nerve Sheath Meningioma in Children. Surv Ophthalmol 2008; 53:543-58. [DOI: 10.1016/j.survophthal.2008.08.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
|
25
|
Chapter 7 Inflammatory Optic Neuropathies Not Associated with Multiple Sclerosis. Neuroophthalmology 2008. [DOI: 10.1016/s1877-184x(09)70037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
|
26
|
Jeremic B, Pitz S. Primary optic nerve sheath meningioma: stereotactic fractionated radiation therapy as an emerging treatment of choice. Cancer 2007; 110:714-22. [PMID: 17582618 DOI: 10.1002/cncr.22859] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Radiotherapy (RT) has occasionally been practiced in the treatment of optic nerve sheath meningioma (ONSM). Recently, stereotactic fractionated RT (SFRT) has been introduced as a tool with better precision for RT delivery. A comprehensive review was undertaken to provide more insight into this matter. METHODS A literature search was performed to identify reports dealing with both clinical aspects (diagnosis) and treatment in ONSM, focusing on RT in primary (p)ONSM. In particular, major emphasis was placed on the role of SFRT in pONSM. RESULTS SFRT was capable of achieving excellent local tumor control, with improved/stable functional capacity in > or = 80%, accompanied with very low toxicity in meticulously planned RT. This holds true for the majority of patients with progressive functional loss and probably the vast majority of those with some degree of functional loss at presentation. Those blind at presentation benefit from postoperative RT, whereas those with only minimal functional loss at presentation must be carefully selected for the best treatment, because a wait-and-see policy will inevitably lead to serious dysfunction or even blindness. CONCLUSIONS SFRT should be considered the treatment of choice for the majority of patients with pONSM. Every effort should be made to further investigate the remaining questions in this disease, such as optimal timing for the patients with no or slight vision loss at presentation.
Collapse
Affiliation(s)
- Branislav Jeremic
- Applied Radiation Biology and Radiotherapy, International Atomic Energy Agency, Vienna, Austria.
| | | |
Collapse
|
27
|
Abstract
The origins of neurosarcoidosis, a multisystemic granulomatous disease, remain unknown. Nervous system localizations remain rare, but severe. Lymphocytic meningitis, psychiatric disorders, diabetes insipidus and cranial nerve palsy are the most frequent signs. Cerebral fluid test and cervical medullar and cerebral MRI with gadolinium have to be performed first. In some cases, histological evidence of granuloma have to be obtained with neuromuscular, meningeal or cerebral biopsies. Functional impairment and life-threatening conditions require early corticosteroid therapy. In worsening cases or in the event of no therapeutic response or poor tolerance to corticosteroids, other immunosuppressive agents should be associated. Maintenance therapy and most often life long maintenance therapy allow a continuous success while avoiding relapse.
Collapse
|
28
|
Abstract
Optic nerve sheath meningiomas are by far the most common tumors of the optic nerve sheath. The diagnosis can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. Observation may be appropriate in patients with mild or no visual deficit or in whom visual loss is not progressing, whereas stereotactic fractionated radiation therapy has been demonstrated to improve or stabilize vision in progressive or advanced cases. Attempts at surgical excision, and even biopsy, of optic nerve sheath meningiomas are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumor with focal involvement of the dural sheath.
Collapse
Affiliation(s)
- Neil R Miller
- Wilmer Eye Institute, the Johns Hopkins Hospital, Baltimore, Maryland, USA.
| |
Collapse
|
29
|
Berman D, Miller NR. New Concepts in the Management of Optic Nerve Sheath Meningiomas. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n3p168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: Primary optic nerve sheath meningiomas (ONSMs) are the most common primary tumours of the optic nerve sheath. The diagnosis and management of ONSMs have changed dramatically in the last decade. In this review article, we discuss the latest information regarding these issues.
Materials and Methods: References for this manuscript were obtained by searching the database PubMed using the phrase “optic nerve sheath meningioma”. Approximately 150 articles were identified and reviewed. These articles served as reference sources for other articles, books and chapters on the subject. The results were combined with our personal experience, which includes over 100 cases of ONSMs that have been observed or treated with one or more of the modalities described below.
Results: The diagnosis of ONSM can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. Management depends on several factors. Observation may be appropriate in patients with mild or no visual deficit or in whom visual loss is not progressing, whereas stereotactic fractionated radiation therapy has been documented to improve or stabilise vision in progressive or advanced cases. Attempts at excision of ONSMs are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumour with focal involvement of the dural sheath. Rare patients with acute visual deterioration may benefit from optic nerve sheath fenestration.
Conclusion: The majority of ONSMs can be suspected on clinical grounds and diagnosed with readily available non-invasive neuroimaging. Stereotactic fractionated radiotherapy is currently the treatment of choice for ONSMs that require therapy.
Key words: Meningioma, Optic nerve, Optic nerve sheath, Radiotherapy
Collapse
Affiliation(s)
- Dalia Berman
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | |
Collapse
|
30
|
|
31
|
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
|
32
|
Abstract
BACKGROUND Meningiomas involving the tuberculum sellae and planum sphenoidale typically cause visual loss by affecting the optic nerve and anterior chiasm. We present a case of a tuberculum sellae meningioma concurrent with lymphomatoid papulosis, a T-cell lymphomatoid skin disorder. CASE REPORT A 50-year-old black woman came to the eye clinic with a symptom of decreased vision in the right eye for one week, especially when reading. Best-corrected vision was counting fingers at two feet O.D. and 20/40 O.S. She was seen seven months earlier, with 20/25 O.D. and O.S. Dilated fundus examination revealed bilateral optic atrophy, O.D. greater than O.S. MRI revealed a meningioma arising from the tuberculum sellae and planum sphenoidale region. The meningioma was partially resected nine days later Visual field performed 18 days postoperatively demonstrated an overall depression in the right eye and no defect in the left eye. Best-corrected vision improved to 20/150 O.D. and 20/30 O.S. CONCLUSION Meningiomas are generally benign tumors that can cause symptoms if vital structures are compromised. Altered visual function and optic atrophy may be the only presentation of intracranial and orbital tumors. Intracranial meningiomas may be associated with systemic conditions that can infiltrate the optic nerve, including lymphocytic disorders. Lymphomatoid papulosis (LyP) is a rare cutaneous disorder involving infiltrating clonal T-cells that has been associated with disseminated lymphomatic skin tumors. It is unclear if there is a direct association between LyP and meningiomas.
Collapse
Affiliation(s)
- Lee Ong
- VA Greater Los Angeles Healthcare System, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, Calfornia, USA.
| | | |
Collapse
|
33
|
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
|
34
|
Cem Y, Basar A, Ozlem O, Nilgul Y, Selcuk P. Primary Bilateral Optic Nerve Sarcoidosis. Neuroophthalmology 2005. [DOI: 10.1080/01658100500218038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
35
|
Frohman LP, Guirgis M, Turbin RE, Bielory L. Sarcoidosis of the Anterior Visual Pathway: 24 New Cases. J Neuroophthalmol 2003; 23:190-7. [PMID: 14504590 DOI: 10.1097/00041327-200309000-00002] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the clinical spectrum and a rational approach to the diagnosis of anterior visual pathway sarcoidosis. METHODS Retrospective chart review of all patients examined in neuro-ophthalmic consultation by 1 author from 1989 to 1998 with a diagnosis of sarcoidosis. RESULTS There were 24 patients (17 female, 7 male, mean age 40 years) with anterior visual pathway sarcoidosis, 17 (71%) of whom were not previously known to have sarcoidosis. Visual acuity ranged from 20/20 to NLP. Normal fundi were observed in 15%. Among the 85% who had fundus abnormalities, pallor was present in 55%, disc edema in 26%, periphlebitis/sheathing in 14%, and optic disc granuloma in 10%. Ten patients (42%) had uveitis, active in only 3 (13%). An elevated angiotensin-converting enzyme (ACE) was present in 16 (76%) of 21 patients tested; evidence of sarcoidosis on chest radiograph was present in 13 (72%) of 18; gallium scanning was abnormal in 13 (93%) of 14; neuroimaging abnormalities of the optic nerves, chiasm, or tract were present in 16 (70%) of 23; lymphocytic pleocytosis or elevated cerebrospinal fluid protein was identified in 14 (88%) of 16 patients, with both values elevated in 7 (44%) patients. Histologic confirmation was obtained in 13 (81%) of 16 who underwent biopsy; in the remaining patients, diagnosis was based entirely on clinical and laboratory evidence. CONCLUSIONS Anterior visual pathway disease may be underrecognized as a presentation of sarcoidosis. Classic fundus findings of periphlebitis and optic granuloma are typically absent. An aggressive diagnostic evaluation may help establish the diagnosis early in its course.
Collapse
Affiliation(s)
- Larry P Frohman
- Institute of Ophthalmology and Visual Sciences, UMDNJ-New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, USA.
| | | | | | | |
Collapse
|
36
|
|
37
|
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
|
38
|
Levine ZT, Buchanan RI, Sekhar LN, Rosen CL, Wright DC. Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas. Neurosurgery 1999; 45:221-30. [PMID: 10449065 DOI: 10.1097/00006123-199908000-00003] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This investigation was performed to construct a grading system for cranial base meningiomas that augments the current system of topographic labeling. This new system classifies cranial base meningiomas based on predicted surgical resection and patient outcomes. METHODS Two hundred thirty-two consecutive patients with cranial base meningiomas were surgically treated by the two senior authors between April 1993 and August 1997. Using standard statistical tests, a large number of preoperative, intraoperative, and follow-up findings were analyzed for correlation with the extent of resection. These included the presence of previous radiotherapy, Cranial Nerve III, V, and VI palsies, multiple fossa involvement, and vessel encasement. RESULTS Analysis revealed that each variable tested was independently and inversely correlated with total tumor resection (P < 0.002). We were able to construct a grading system based on these variables; when more variables are present, the grade is higher. With the grading system, lower-grade tumors were correlated with increased probabilities of total resection (r2 = 0.9947) and better patient outcomes, as measured by Karnofsky performance scale scores (r = 0.9291). We also found that, as a group, patients who underwent subtotal resection exhibited worse Karnofsky performance scale scores and had longer hospital stays. CONCLUSION The current system of classifying cranial base meningiomas provides no information regarding the tumor except location and no information concerning patient prognosis. We present a more useful system to categorize these tumors. Our scheme must be tested at other centers to corroborate our findings. This new grading system should serve to guide surgical treatment, inform patients, and improve communication among surgeons.
Collapse
Affiliation(s)
- Z T Levine
- Department of Neurological Surgery, George Washington University Medical Center, Washington, District of Columbia, USA
| | | | | | | | | |
Collapse
|
39
|
Chapman KL, Bartley GB, Garrity JA, Gonnering RS. Lacrimal bypass surgery in patients with sarcoidosis. Am J Ophthalmol 1999; 127:443-6. [PMID: 10218697 DOI: 10.1016/s0002-9394(98)00420-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the results of lacrimal bypass surgery in patients with sarcoidosis. METHODS Patients with sarcoidosis who underwent dacryocystorhinostomy (DCR) or conjunctivodacryocystorhinostomy (CDCR) in two practice settings from 1986 through 1995 were identified and their medical records reviewed. RESULTS Twelve patients, of whom eight were women, underwent bilateral DCR or CDCR to treat nasolacrimal duct obstruction associated with sarcoidosis. The initial diagnosis of sarcoidosis was established in four patients from a biopsy specimen obtained during DCR. The ages of the patients at diagnosis of sarcoidosis ranged from 39 to 64 years (mean, 49.6 years; median, 45.5 years), whereas their ages at the time of surgery ranged from 42 to 72 years (mean and median, 55 years). The average duration of postoperative follow-up evaluation was 44 months (median, 38.5 months; range, 10 to 82 months). All patients received local corticosteroids postoperatively, and nine patients (75%) were treated with prednisone. Of the 24 lacrimal procedures, 23 (95.8%) were patent to irrigation at the last follow-up examination, and all patients were asymptomatic. CONCLUSION Lacrimal drainage obstruction may be the initial manifestation of sarcoidosis, and tissue obtained during DCR may help to establish the diagnosis. A successful surgical outcome may require intensive and occasionally long-term therapy with local and systemic corticosteroids.
Collapse
Affiliation(s)
- K L Chapman
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
40
|
Mafee MF, Dorodi S, Pai E. Sarcoidosis of the eye, orbit, and central nervous system. Role of MR imaging. Radiol Clin North Am 1999; 37:73-87, x. [PMID: 10026730 DOI: 10.1016/s0033-8389(05)70079-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sarcoidosis, a systemic disease of unknown cause, frequently involves the eye, orbit, and central nervous system. The MR imaging findings of orbital and optic pathway sarcoidosis may closely resemble several other orbital and intracranial diseases. This article reviews MR imaging findings of sarcoidosis when it involves the eye, orbit, and visual pathways. Careful review of MR findings and other neuroimaging findings and clinical characteristics will reduce the incidence of mistaking optic nerve and chiasmal sarcoidosis for meningioma or glioma.
Collapse
Affiliation(s)
- M F Mafee
- Department of Radiology, University of Illinois at Chicago, USA
| | | | | |
Collapse
|
41
|
Abstract
Optic nerve meningiomas usually are seen in middle-aged and elderly women, and present as a slowly progressing axial proptosis and loss of vision. CT and MR imaging are the most valuable diagnostic tools to evaluate these tumors. This article reviews the MR imaging and CT characteristics of optic nerve sheath meningiomas and discusses features that may distinguish optic nerve sheath meningiomas from simulating lesions.
Collapse
Affiliation(s)
- M F Mafee
- Department of Radiology, University of Illinois at Chicago, USA.
| | | | | |
Collapse
|
42
|
Brändle U, Kohler K, Wheeler-Schilling TH. Expression of the P2X7-receptor subunit in neurons of the rat retina. BRAIN RESEARCH. MOLECULAR BRAIN RESEARCH 1998; 62:106-9. [PMID: 9795168 DOI: 10.1016/s0169-328x(98)00254-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the considerable evidence of signaling by extracellular nucleotides in other sensory systems, few studies have been undertaken in the eye. Molecular and immunohistochemical methods were used to demonstrate the expression and cellular localization of the P2X7 receptor subunit in the retina and choroid. RT-PCR was used for the detection of P2X7 subunit mRNA in the rat of different postnatal developmental stages (P23-P210) and revealed the presence of P2X7-mRNA in the retina, but not in the choroid. In the adult rat retina, immunolabelling for P2X7 was detected in a number of cells in the inner nuclear layer (INL) and ganglion cell layer (GCL), suggesting different types of amacrine cells and ganglion cells. These results demonstrate for the first time the expression of the P2X7 receptor in the mammalian retina and furthermore in distinct neuronal cell populations. Our data suggest that extracellular ATP may provide both neuromodulatory and trophic influences on visual processing.
Collapse
Affiliation(s)
- U Brändle
- Department of Otolaryngology, University of Tuebingen, Roentgenweg 11, 72076, Tuebingen, Germany
| | | | | |
Collapse
|
43
|
Abstract
In many neurologic diseases, activated leukocytes enter the nervous system and initiate a chronic inflammatory process. Understanding how the cellular and humoral responses are associated with pathogenesis is essential for the formulation of a unifying model of central and peripheral nervous system inflammation. Based on such a model, immunotherapeutic strategies and protocols can be designed.
Collapse
|