Presentation
Loss of vision in left eye
Patient Data
A fairly well-defined extra-axial lesion is seen along planum sphenoidale, extending to the suprasellar region. The lesion is indenting the pituitary gland inferiorly. It splays and compresses the optic chiasma superiorly and extends into the left optic canal and encases canalicular, intracranial segments of the left optic nerve. It indents the intracranial segment of the right optic nerve, pituitary stalk and bilateral basal frontal lobes. It partially encases the supraclinoid segment of the left ICA and indents the A1 segments of both ACA. Post-contrast scans show homogeneous enhancement of the lesion with adjacent dural enhancement. There is reduced caliber of the left optic nerve with a prominence of the perioptic CSF space consistent with optic atrophy.
A second, much smaller similar lesion is located just below the torcula.
Conclusion:
Planum sphenoidale meningioma extending into the left optic canal and causing optic atrophy with a second smaller meningioma just below the torcula.
Case Discussion
This case illustrates the importance of assessing the optic nerves when dealing with lesions in the sellar region. This can have a substantial impact on operative or radiotherapy planning.
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