PubMed · 6964220
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M D Sanders. 1981. Computerized tomography.. https://pubmed.ncbi.nlm.nih.gov/6964220/
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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 55-year-old male presented with hearing disturbance and tinnitus in the left ear. Computed tomography (CT) and magnetic resonance imaging demonstrated a well-defined, homogeneously enhanced mass in the left cerebellomedullary cistern without extension close to the jugular foramen. A three-dimensional image reconstructed from thin-slice CT scans demonstrated that the mass was clearly separated from the jugular foramen. The mass lesion was totally removed surgically. At surgery the tumor was found to originate from one rootlet of the vagal nerve just after its exit from the medulla oblongata. The histological diagnosis was neurinoma. Intracranial neurinomas of the glossopharyngeal, vagal, or accessory nerve usually originate within or close to the jugular foramen. This unusual location made it difficult to achieve a correct preoperative diagnosis.
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.