Abstract
BackgroundOptic nerve sheath meningiomas account for only 2 % of orbital lesions and 42 % of optic nerve tumors. Diagnosis remains difficult because histologic confirmation carries a high risk of visual loss. Therefore, a less invasive and specific diagnostic method for differentiating optic nerve sheath meningiomas from other optic nerve lesions is needed to overcome the limitations of computed tomography and magnetic resonance imaging, and make the best individualized treatment decision. This case is a good illustration of the clinical and imaging difficulties inherent in this rare tumor, which may be hard to differentiate from other causes.Case presentationA 51-year-old Caucasian woman developed a central scotoma, visual loss, and abnormal visual evoked potentials. The first magnetic resonance imaging scan classified the optic nerve damage as retrobulbar optic neuritis. After magnetic resonance imaging follow-up at 3 months, a negative lumbar puncture and biological workup, and clinical worsening, an optic nerve sheath meningioma was suspected. We confirmed this diagnosis with 111In-pentetreotide single-photon emission computed tomography, which is able to bind with very high affinity to somatostatin receptor subtype 2 expressed on meningiomas.ConclusionsIn the diagnosis of optic nerve sheath meningiomas, [111In]-pentetreotide single-photon emission computed tomography-fused magnetic resonance imaging is a valuable additional tool, optimizing the diagnosis and obviating the need for a more invasive procedure.
Highlights
Optic nerve sheath meningiomas account for only 2 % of orbital lesions and 42 % of optic nerve tumors
We present a case of Optic nerve sheath meningiomas (ONSMs) diagnosed using [111In]pentetreotide single-photon emission computed tomography/computed tomography (SPECT/CT) in a patient initially followed for a diagnosis of optic neuritis
Case presentation A 51-year-old Caucasian woman initially consulted for right visual loss (2/10, with corrective lenses) and central scotoma demonstrated with perimetry
Summary
Optic nerve sheath meningiomas (ONSMs) account for 2 % of orbital lesions and are the second most common optic nerve tumors, after optic nerve gliomas [1,2,3,4]. We present a case of ONSM diagnosed using [111In]pentetreotide single-photon emission computed tomography/computed tomography (SPECT/CT) in a patient initially followed for a diagnosis of optic neuritis. Case presentation A 51-year-old Caucasian woman initially consulted for right visual loss (2/10, with corrective lenses) and central scotoma demonstrated with perimetry. SPECT/CT was performed 24 h after injection of 180 MBq [111In]-pentetreotide and showed an intense uptake in the last third of the intraorbital right optic nerve (Fig. 1d and h) corresponding to the contrast enhancement on the MRI scan. After this confirmation, she was referred to the radiotherapy center for stereotaxic radiotherapy. The 1-year clinical follow-up was positive with disappearance of the Marcus Gunn pupil sign, better visual acuity (7/10, with corrective lenses), and stability on MRI imaging
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