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Exostosis of the optic canal in a child--a rare diagnosis in a paediatric ear, nose and throat setting: a case report.

Urík M, Šlapák I, Pavlovská D, Prívarová E - J Med Case Rep (2014)

Bottom Line: Using modern imaging techniques and endonasal endoscopic surgery, we identified the cause and removed the pathology.It is a gentle and minimally invasive surgical technique.Interdisciplinary cooperation, especially with the eye doctor and radiologist, is required in these cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and University Hospital Brno 1, Cernopolni 9, 61300, Brno, Czech Republic. docttor.urik@gmail.com.

ABSTRACT

Introduction: Optic nerve compression is an uncommon disorder leading to deterioration or complete loss of vision.

Case presentation: We describe the case of a 14-year-old Caucasian girl with a gradual deterioration of vision in her right eye. Using modern imaging techniques and endonasal endoscopic surgery, we identified the cause and removed the pathology.

Conclusions: The cause of optic nerve compression was a rare exostosis in the optic canal. An endonasal endoscopic approach is the optimal choice for management of optic nerve pathologies. It is a gentle and minimally invasive surgical technique. Interdisciplinary cooperation, especially with the eye doctor and radiologist, is required in these cases.

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Pathology of the right optic nerve (*) – postcontrast magnetic resonance imaging.
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Fig1: Pathology of the right optic nerve (*) – postcontrast magnetic resonance imaging.

Mentions: In February 2007, a 14-year-old Caucasian girl was admitted to our Ear, Nose and Throat department. Since the beginning of 2006 she has been monitored for gradual loss of vision in her right eye. At the out-patient eye clinic of our hospital, she was diagnosed with reduced vision in her right eye due to partial atrophy of her optic nerve. Her vision ranges from 2 to 4m; the use of optical correction fails to improve the condition. The position of her eyes is parallel, her eyeballs are movable in all directions, the anterior segment is intact, optic media are transparent, and pale atrophic papillae are seen in the right fundus; the findings are unchanged without progression. The findings in the left fundus are physiological. Baseline perimetry revealed absolute central scotoma up to 25 degrees, which coincides with the blind spot. Eye findings correspond to optic nerve compression. In May 2006, magnetic resonance imaging (MRI) scanning was performed with the conclusion of suspected tumour of the prechiasmatic segment of her right optic nerve. In the summer of 2006, a temporary improvement in clinical symptoms occurred; however, during the autumn of the same year her symptoms worsened again and she developed headaches in addition to visual problems. In December 2006, a follow-up MRI scan was performed and revealed significant enlargement of the subarachnoid space of her right optic nerve (Figures 1 and 2). An enlarged bony structure was also seen laterally in the optic canal area, which was surrounded by solid tissue, probably compressing the optic nerve in the optic canal. An additional computed tomography (CT) scan was performed, which revealed a robust anterior clinoid process (Figures 3, 4, 5 and 6) and otherwise no further pathology.Figure 1


Exostosis of the optic canal in a child--a rare diagnosis in a paediatric ear, nose and throat setting: a case report.

Urík M, Šlapák I, Pavlovská D, Prívarová E - J Med Case Rep (2014)

Pathology of the right optic nerve (*) – postcontrast magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307678&req=5

Fig1: Pathology of the right optic nerve (*) – postcontrast magnetic resonance imaging.
Mentions: In February 2007, a 14-year-old Caucasian girl was admitted to our Ear, Nose and Throat department. Since the beginning of 2006 she has been monitored for gradual loss of vision in her right eye. At the out-patient eye clinic of our hospital, she was diagnosed with reduced vision in her right eye due to partial atrophy of her optic nerve. Her vision ranges from 2 to 4m; the use of optical correction fails to improve the condition. The position of her eyes is parallel, her eyeballs are movable in all directions, the anterior segment is intact, optic media are transparent, and pale atrophic papillae are seen in the right fundus; the findings are unchanged without progression. The findings in the left fundus are physiological. Baseline perimetry revealed absolute central scotoma up to 25 degrees, which coincides with the blind spot. Eye findings correspond to optic nerve compression. In May 2006, magnetic resonance imaging (MRI) scanning was performed with the conclusion of suspected tumour of the prechiasmatic segment of her right optic nerve. In the summer of 2006, a temporary improvement in clinical symptoms occurred; however, during the autumn of the same year her symptoms worsened again and she developed headaches in addition to visual problems. In December 2006, a follow-up MRI scan was performed and revealed significant enlargement of the subarachnoid space of her right optic nerve (Figures 1 and 2). An enlarged bony structure was also seen laterally in the optic canal area, which was surrounded by solid tissue, probably compressing the optic nerve in the optic canal. An additional computed tomography (CT) scan was performed, which revealed a robust anterior clinoid process (Figures 3, 4, 5 and 6) and otherwise no further pathology.Figure 1

Bottom Line: Using modern imaging techniques and endonasal endoscopic surgery, we identified the cause and removed the pathology.It is a gentle and minimally invasive surgical technique.Interdisciplinary cooperation, especially with the eye doctor and radiologist, is required in these cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and University Hospital Brno 1, Cernopolni 9, 61300, Brno, Czech Republic. docttor.urik@gmail.com.

ABSTRACT

Introduction: Optic nerve compression is an uncommon disorder leading to deterioration or complete loss of vision.

Case presentation: We describe the case of a 14-year-old Caucasian girl with a gradual deterioration of vision in her right eye. Using modern imaging techniques and endonasal endoscopic surgery, we identified the cause and removed the pathology.

Conclusions: The cause of optic nerve compression was a rare exostosis in the optic canal. An endonasal endoscopic approach is the optimal choice for management of optic nerve pathologies. It is a gentle and minimally invasive surgical technique. Interdisciplinary cooperation, especially with the eye doctor and radiologist, is required in these cases.

Show MeSH
Related in: MedlinePlus