J Korean Neurosurg Soc.  2016 Sep;59(5):525-528. 10.3340/jkns.2016.59.5.525.

Penetration and Splitting of Optic Nerve by Tuberculum Sellae Meningioma

• Park SC
• Lee SH

• KMID: 2351724
• DOI: http://doi.org/10.3340/jkns.2016.59.5.525

Abstract

Preservation of the optic nerves is an important issue in the resection of tuberculum sellae meningiomas. We report the case of a patient whose optic nerve was penetrated by a tuberculum sellae meningioma. During surgery, a bulging tumor was found to penetrate the right optic nerve. The tumor was gross totally removed, including tumors bulging through the optic nerve. Two trunks of the split optic nerve were preserved. The penetrated shape of the optic nerve may lead to misjudgment and its damage. Divided trunks of optic nerves are difficult to recognize and may be confused for the tumor capsule, because they may be thinned and seem to contain tumors. In addition, a single trunk may be confused for the whole nerve; thus, the other trunk may be easily damaged if not dissected cautiously. Treatment strategy according to the remnant visual acuity was suggested.

Keyword

Meningioma; Optic nerve; Penetration; Visual acuity

MeSH Terms

Humans
Meningioma*
Optic Nerve*
Visual Acuity

Figure

• 

  Fig. 1 Preoperative coronal (A) and sagittal (B) T1-weighted enhanced magnetic resonance images of the tuberculum sellae meningioma. Optic nerve penetration could not be identified in preoperative images.

• 

  Fig. 2 Introperative images (A) bulged tumors (black arrow) through the two trunks of the right optic nerves were found. (B) Penetration into the optic nerve during tumor resection. There were remnant tumors between the suction tip and optic canal and between the optic nerve and internal carotid artery. These tumors were further removed gross totally. The tumor was whitish with low vascularity.

• 

  Fig. 3 Postoperative coronal (A) and sagittal (B) T1-weighted enhanced magnetic resonance images. No remnant tumor was identified.

• 

  Fig. 4 Preoperative visual field of the left eye 1 month before the operation (A) and postoperative visual field of the left eye 1 month after the operation (B). Outermost green line indicates the visual field that can identify a 64-mm2 sized object. Inner two red lines indicate visual fields that can identify 4-mm2 and 1/4-mm2 sized objects. The right eye was blind and a visual field examination was impossible.

Reference

1. Beatty RA. Splitting of the optic nerve by a carotid-ophthalmic artery aneurysm. Case report. J Neurosurg. 1986; 65:560–562. PMID: 3760967.

2. Date I, Akioka T, Ohmoto T. Penetration of the optic chiasm by a ruptured anterior communicating artery aneurysm. Case report. J Neurosurg. 1997; 87:324–326. PMID: 9254100.

3. Feliciano CE, Samson D. Split optic nerve penetrated by a carotid-ophthalmic aneurysm another instance of a rare presentation : a case report. IJCRI. 2012; 3:39–44.

4. Fujita A, Tamaki N, Yasuo K, Nagashima T, Ehara K. Complete penetration of the optic chiasm by an unruptured aneurysm of the ophthalmic segment : case report. Surg Neurol. 2002; 57:130–134. PMID: 11904210.

5. Gagliardi F, Boari N, Losa M, Mortini P. Longitudinal splitting of optic pathways by non-functioning pituitary macroadenoma : report of two cases. Acta Neurochir (Wien). 2010; 152:1065–1068. discussion 1068. PMID: 19826754.

6. House PA, Couldwell WT. De novo fenestration of the optic nerve. Case illustration. J Neurosurg. 2005; 102:390. PMID: 15739573.

7. Jallo GI, Benjamin V. Tuberculum sellae meningiomas : microsurgical anatomy and surgical technique. Neurosurgery. 2002; 51:1432–1439. discussion 1439-1440. PMID: 12445348.

8. Jea A, Başkaya MK, Morcos JJ. Penetration of the optic nerve by an internal carotid artery-ophthalmic artery aneurysm : case report and literature review. Neurosurgery. 2003; 53:996–999. discussion 999-1000. PMID: 14519234.

9. Joo SP, Kim TS. Splitting of the optic nerve associated with ruptured anterior communicating artery aneurysm. Neurol Med Chir (Tokyo). 2007; 47:501–502. PMID: 18037803.

10. Kanamaru K, Ishida F, Taki W. Splitting and penetration of the optic nerve by an aneurysm arising from the anterior wall of internal carotid artery : case report. J Neurol Neurosurg Psychiatry. 2001; 71:525–527. PMID: 11561040.

11. Margalit NS, Lesser JB, Moche J, Sen C. Meningiomas involving the optic nerve : technical aspects and outcomes for a series of 50 patients. Neurosurgery. 2003; 53:523–532. discussion 532-533. PMID: 12943569.

12. Mathiesen T, Kihlström L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery. 2006; 59:570–576. discussion 570-576. PMID: 16955039.

13. Narayan S, Cornblath WT, Sandler HM, Elner V, Hayman JA. Preliminary visual outcomes after three-dimensional conformal radiation therapy for optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys. 2003; 56:537–543. PMID: 12738331.

14. Panciani PP, Crobeddu E, Garbossa D, Ducati A, Fontanella M. Optic nerve fenestration in sphenoid wing meningioma. Neurol India. 2011; 59:461–463. PMID: 21743184.

15. Schick U, Hassler W. Surgical management of tuberculum sellae meningiomas : involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry. 2005; 76:977–983. PMID: 15965205.

16. Takagi Y, Miyamoto S. Penetration of the optic nerve and falciform ligament by an internal carotid artery-ophthalmic artery aneurysm : case report. Neurol Med Chir (Tokyo). 2014; 54:211–213. PMID: 24140766.

17. Wang YY, Thani NB, Han TF. Optic nerve penetration by a carotico-ophthalmic artery aneurysm. J Clin Neurosci. 2010; 17:931–933. PMID: 20399662.