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A Rare Case of Optic Nerve Schwannoma: Case Report and Review of the Literature.

Ramey WL, Arnold SJ, Chiu A, Lemole M - Cureus (2015)

Bottom Line: Additionally, because of its medial position relative to the optic nerve and within the orbital apex, it is the first such case to be resected via an endoscopic endonasal approach.The lesion was subtotally resected because of its adherence and continuity with the optic nerve and the patient's wish to preserve his vision.He was subsequently referred to radiation oncology for external beam radiation therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, University of Arizona.

ABSTRACT

Background and importance: Schwannomas are typically benign tumors of the peripheral nervous system that originate from Schwann cells. It is well known that the optic nerves are myelinated by oligodendrocytes since their cell bodies arise centrally within the lateral geniculate nuclei. Because of this basic cellular anatomy, optic schwannomas should theoretically not exist. It is possible, however, these rare lesions stem from small sympathetic fibers that innervate the vasculature surrounding the optic nerve and its sheath.

Clinical presentation: The patient is a 46-year-old male with a one-year history of progressive right eye blurry vision. To our knowledge, there are only five known reported case of an optic nerve schwannoma. Additionally, because of its medial position relative to the optic nerve and within the orbital apex, it is the first such case to be resected via an endoscopic endonasal approach. The lesion was subtotally resected because of its adherence and continuity with the optic nerve and the patient's wish to preserve his vision. He was subsequently referred to radiation oncology for external beam radiation therapy.

Conclusion: Herein, we discuss the pertinent clinical findings of this rare lesion and review the literature relative to optic nerve and solitary orbital schwannomas.

No MeSH data available.


Related in: MedlinePlus

Preoperative T1-weighted MRI with contrastAxial view showing a small enhancing lesion along the optic nerve at the orbital apex pointed out by the white arrow (A). Coronal (B) and sagittal (C) views again showing the enhancing orbital mass.
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FIG1: Preoperative T1-weighted MRI with contrastAxial view showing a small enhancing lesion along the optic nerve at the orbital apex pointed out by the white arrow (A). Coronal (B) and sagittal (C) views again showing the enhancing orbital mass.

Mentions: The patient is a 46-year-old male who presented to the neurosurgery clinic with a one-year history of progressive right eye blurry vision, which he first noticed while serving as an umpire in a little league baseball game. He denied any headaches, although he had recently developed a painless pressure sensation behind the right eye. He had no contributory medical history (e.g. endocrinologic, vascular) to explain an optic mononeuritis, and there was no personal or family history of neurofibromatosis. An evaluation by neuro-ophthalmology showed severe degradation of the right eye visual fields with sparing only of the inferior medial field. Right optic atrophy was also appreciated on examination. Physical examination in the neurosurgery clinic was unremarkable for any focal neurological findings, and both of his pupils were equal, round, and reactive to light and accommodation. A T1-weighted MRI with contrast demonstrated a 4 x 5 mm homogeneously enhancing mass at the right orbital apex within the bony canal and along the medial aspect of the right optic nerve sheath with resultant mass effect on the right optic nerve (Figure 1).


A Rare Case of Optic Nerve Schwannoma: Case Report and Review of the Literature.

Ramey WL, Arnold SJ, Chiu A, Lemole M - Cureus (2015)

Preoperative T1-weighted MRI with contrastAxial view showing a small enhancing lesion along the optic nerve at the orbital apex pointed out by the white arrow (A). Coronal (B) and sagittal (C) views again showing the enhancing orbital mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494577&req=5

FIG1: Preoperative T1-weighted MRI with contrastAxial view showing a small enhancing lesion along the optic nerve at the orbital apex pointed out by the white arrow (A). Coronal (B) and sagittal (C) views again showing the enhancing orbital mass.
Mentions: The patient is a 46-year-old male who presented to the neurosurgery clinic with a one-year history of progressive right eye blurry vision, which he first noticed while serving as an umpire in a little league baseball game. He denied any headaches, although he had recently developed a painless pressure sensation behind the right eye. He had no contributory medical history (e.g. endocrinologic, vascular) to explain an optic mononeuritis, and there was no personal or family history of neurofibromatosis. An evaluation by neuro-ophthalmology showed severe degradation of the right eye visual fields with sparing only of the inferior medial field. Right optic atrophy was also appreciated on examination. Physical examination in the neurosurgery clinic was unremarkable for any focal neurological findings, and both of his pupils were equal, round, and reactive to light and accommodation. A T1-weighted MRI with contrast demonstrated a 4 x 5 mm homogeneously enhancing mass at the right orbital apex within the bony canal and along the medial aspect of the right optic nerve sheath with resultant mass effect on the right optic nerve (Figure 1).

Bottom Line: Additionally, because of its medial position relative to the optic nerve and within the orbital apex, it is the first such case to be resected via an endoscopic endonasal approach.The lesion was subtotally resected because of its adherence and continuity with the optic nerve and the patient's wish to preserve his vision.He was subsequently referred to radiation oncology for external beam radiation therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, University of Arizona.

ABSTRACT

Background and importance: Schwannomas are typically benign tumors of the peripheral nervous system that originate from Schwann cells. It is well known that the optic nerves are myelinated by oligodendrocytes since their cell bodies arise centrally within the lateral geniculate nuclei. Because of this basic cellular anatomy, optic schwannomas should theoretically not exist. It is possible, however, these rare lesions stem from small sympathetic fibers that innervate the vasculature surrounding the optic nerve and its sheath.

Clinical presentation: The patient is a 46-year-old male with a one-year history of progressive right eye blurry vision. To our knowledge, there are only five known reported case of an optic nerve schwannoma. Additionally, because of its medial position relative to the optic nerve and within the orbital apex, it is the first such case to be resected via an endoscopic endonasal approach. The lesion was subtotally resected because of its adherence and continuity with the optic nerve and the patient's wish to preserve his vision. He was subsequently referred to radiation oncology for external beam radiation therapy.

Conclusion: Herein, we discuss the pertinent clinical findings of this rare lesion and review the literature relative to optic nerve and solitary orbital schwannomas.

No MeSH data available.


Related in: MedlinePlus