Optic Nerve (Cranial Nerve II)

Introduction: Optic nerve sheath meningiomas and intracavernous arachnoid cysts are both fairly rare conditions, and to the best of our knowledge, have not been previously reported to co-occur in the same patient. Both can cause diplopia, but only ONSMs have been documented to demonstrate progressive worsening of ocular motility. Case Report: A 67-year-old woman with blur and diplopia demonstrated a right optic neuropathy and limited ductions bilaterally. Neuroimaging revealed a right optic nerve sheath meningioma and left intracavernous arachnoid cyst. She was conservatively managed with neurosurgical surveillance for 1.5 years, until her diplopia worsened. Ocular motility re-evaluation demonstrated a worsening left abduction deficit, suggesting interval change of the intracavernous cyst, rather than the meningioma. Conclusion: There are only a few reported cases of cranial nerve VI palsy secondary to a cavernous sinus arachnoid cyst. However, this is the first reported case in a patient with a concurrent optic nerve sheath meningioma, and the first case demonstrating progressive worsening of a sixth cranial nerve palsy from an intracavernous arachnoid cyst. Determining which comorbidity caused worsening of symptoms played a critical role in the management of this patient.

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Cranial nerve threshold for thermal injury induced by MRI-guided high-intensity focused ultrasound (MRgHIFU): preliminary results on an optic nerve model

IEEE Transactions on Ultrasonics Ferroelectrics and Frequency Control ◽

10.1109/tuffc.2013.2618 ◽

2013 ◽

Vol 60 (4) ◽

pp. 702-705 ◽

Cited By ~ 8

Author(s):

Sagi Harnof ◽

Zion Zibly ◽

Zvi Cohen ◽

Andrew Shaw ◽

Cody Schlaff ◽

...

Keyword(s):

Optic Nerve ◽

High Intensity ◽

Cranial Nerve ◽

Thermal Injury ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Preliminary Results ◽

Nerve Model ◽

Mri Guided

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Neuro-ophthalmology

Training in Ophthalmology ◽

10.1093/med/9780199237593.003.0009 ◽

2009 ◽

Author(s):

Venki Sundaram ◽

John Elston

Keyword(s):

Optic Nerve ◽

Cranial Nerve ◽

Visual Loss ◽

Clinical Skills ◽

Visual Pathway ◽

Sudden Onset ◽

Acute Visual Loss ◽

Cranial Nerve Palsies ◽

Optic Nerve Disorders ◽

Eye Movement Disorders

The chapter begins by discussing the visual pathway and pupil reflex anatomy and cranial nerve anatomy, before covering the key clinical skills, namely neuro-ophthalmology history taking, neuro-ophthalmology examination, and neuroimaging. It then covers the key areas of clinical knowledge, including chiasmal visual pathway disorders, retrochiasmal visual pathway disorders, optic nerve disorders, papilloedema and idiopathic intracranial hypertension, congenital optic nerve disorders, cranial nerve palsies, nystagmus, supranuclear eye movement disorders, pupil abnormalities, headache, non-organic visual loss, neuromuscular junction disorders, and ocular myopathies. The chapter concludes with five case-based discussions, on acute visual loss, sudden-onset diplopia, headache, anisocoria, and nystagmus.

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Outcomes of decompressive surgery for cavernous sinus meningiomas: long-term follow-up in 50 patients

Journal of Neurosurgery ◽

10.3171/2018.10.jns181480 ◽

2020 ◽

Vol 132 (2) ◽

pp. 380-387 ◽

Cited By ~ 7

Author(s):

Yair M. Gozal ◽

Gmaan Alzhrani ◽

Hussam Abou-Al-Shaar ◽

Mohammed A. Azab ◽

Michael T. Walsh ◽

...

Keyword(s):

Optic Nerve ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Tumor Resection ◽

Lateral Wall ◽

Senior Author ◽

Tumor Control ◽

Subtotal Resection ◽

Adjuvant Radiation ◽

Neurological Morbidity

OBJECTIVECavernous sinus meningiomas are complex tumors that offer a perpetual challenge to skull base surgeons. The senior author has employed a management strategy for these lesions aimed at maximizing tumor control while minimizing neurological morbidity. This approach emphasizes combining “safe” tumor resection and direct decompression of the roof and lateral wall of the cavernous sinus as well as the optic nerve. Here, the authors review their experience with the application of this technique for the management of cavernous sinus meningiomas over the past 15 years.METHODSA retrospective analysis was performed for patients with cavernous sinus meningiomas treated over a 15-year period (2002–2017) with this approach. Patient outcomes, including cranial nerve function, tumor control, and surgical complications were recorded.RESULTSThe authors identified 50 patients who underwent subtotal resection via frontotemporal craniotomy concurrently with decompression of the cavernous sinus and ipsilateral optic nerve. Of these, 25 (50%) underwent adjuvant radiation to the remaining tumor within the cavernous sinus. Patients most commonly presented with a cranial nerve (CN) palsy involving CN III–VI (70%), a visual deficit (62%), headaches (52%), or proptosis (44%). Thirty-five patients had cranial nerve deficits preoperatively. In 52% of these cases, the neuropathy improved postoperatively; it remained stable in 46%; and it worsened in only 2%. Similarly, 97% of preoperative visual deficits either improved or were stable postoperatively. Notably, 12 new cranial nerve deficits occurred postoperatively in 10 patients. Of these, half were transient and ultimately resolved. Finally, radiographic recurrence was noted in 5 patients (10%), with a median time to recurrence of 4.6 years.CONCLUSIONSThe treatment of cavernous sinus meningiomas using surgical decompression with or without adjuvant radiation is an effective oncological strategy, achieving excellent tumor control rates with low risk of neurological morbidity.

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Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function

Journal of Neurosurgery ◽

10.3171/jns.2006.105.1.148 ◽

2006 ◽

Vol 105 (1) ◽

pp. 148-152 ◽

Cited By ~ 51

Author(s):

William T. Couldwell ◽

Peter Kan ◽

James K. Liu ◽

Ronald I. Apfelbaum

Keyword(s):

Optic Nerve ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Combined Therapy ◽

Growth Control ◽

Good Control ◽

Neural Function ◽

Nerve Function ◽

Cavernous Sinus Meningioma ◽

Cranial Nerve Function

✓ Meningiomas are the most common tumors affecting the cavernous sinus (CS). Despite advances in microsurgery and radiosurgery, treatment of CS meningiomas remains difficult and controversial. As in cases of other meningiomas, the goal of treatment for CS meningioma is long-term growth control and preservation of neural function. Gross-total resection, the ideal treatment for meningioma, is not always possible to obtain in patients with CS meningiomas with an acceptable level of morbidity. Therefore, microsurgery and radiosurgery have recently been advocated as a combined therapy to achieve good control of tumor growth and favorable functional outcome. The authors describe a technique in which tumor volume can be reduced to a minimal residual amount, while preserving cranial nerve function. This enables the smallest field to be treated radiosurgically. The optic nerve is decompressed, and the tumor mass is reduced to provide at least a 5-mm interpositional distance between the optic nerve and the residual lesion. Direct decompression of the CS, with opening of the lateral and superior sinus walls, and piecemeal removal of the tumor in “safe” locations are performed to facilitate an improvement in cranial nerve function. The authors describe the use of this technique in a series of patients and demonstrate improvement of cranial nerve function in a subset of these patients.

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