Sphenoid Meningioma

    • Tumor growing from the meninges of the lesser wing and body of the sphenoid bone
    • Brain MRI is usually diagnostic
    • Middle-aged women are most at risk
    • Treated with surgery and/or radiation
    • Core clinical features
      • Slowly progressive monocular or binocular visual loss
      • Reduced visual acuity
      • Nerve fiber bundle and/or hemianopic defects
      • Afferent pupil defect unless damage is equal in both eyes
      • Optic discs appear normal or pale
    • Imaging features
      • MRI shows an enhancing mass based at the lesser wing or body of the sphenoid bone often inducing bone growth and even invading the orbit
    • Other masses in the sellar region
    • Arachnoid cyst
    • Langerhans cell histiocytosis
    • Sphenoid sinusitis or mucocele
    • Lymphocytic hypophysitis
    • Pituitary abscess
    • Multiple sclerosis
    • Neuromyelitis optica
    • Sarcoidosis
    • Radiation damage
    • Order brain MRI
    • Order maxillofacial CT to improve assessment of bone invasion or bone induction
    • Tip: non-contrast CT may miss the tumor because the tumor has the same radiodensity as adjacent brain parenchyma
    • Untreated tumors may grow slowly, but growth often stops after menopause
    • Endonasal or transcranial surgery is advised if
      • Vision attributable to tumor is declining
      • Mass is large or enlarging
      • Surgical risk is acceptable
    • Expect skilled surgery to improve or stabilize vision in 75%, worsen vision in less than 25%
    • Trap: large and invasive lesions pose extra surgical hazards and often cannot be entirely excised without harming vision
    • Trap: if the tumor has invaded the optic canal, a feature not easily evident on imaging, the prognosis for post-operative visual recovery is less favorable
    • Radiation therapy is preferred over surgery to stabilize vision if the surgical risk is high or surgery leaves a large residual or recurring tumor
    • Trap: radiation therapy does not improve vision, may rarely worsen it after months to years, and may pose long-term risks of stroke, hypopituitarism, dementia, vasculopathy, and development of a second intracranial tumor

    Optic Nerve And Chiasm Disorders

    Drusen Optic Neuropathy Colobomatous Optic Neuropathy Optic Pit Neuropathy Morning Glory Optic Neuropathy Hypoplastic Optic Neuropathy Typical Optic Neuritis Atypical Optic Neuritis Papillitis (Neuroretinitis) Non-arteritic Ischemic Optic Neuropathy Arteritic Ischemic Optic Neuropathy Posterior Ischemic Optic Neuropathy Hypotensive Ischemic Optic Neuropathy Radiation-induced Optic Neuropathy Diabetic Papillopathy Hypertensive Optic Disc Edema Papilledema Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Compressive Optic Neuropathy: Overview Optic Neuropathy of Graves Disease Optic Nerve Sheath Meningioma Sphenoid Meningioma Craniopharyngioma Pituitary Adenoma Pilocytic Astrocytoma (Optic Glioma) Carotid Aneurysm Suprasellar Germinoma Infiltrative (Neoplastic) Optic Neuropathy Paraneoplastic Optic Neuropathy Traumatic Optic Neuropathy Toxic Optic Neuropathy Nutritional Deficiency Optic Neuropathy Dominantly-Inherited Optic Neuropathy Leber Hereditary Optic Neuropathy Primary Open Angle Glaucoma