Tumours, masses and neoplasia
Meningioma
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Get access- Slow-growing tumours of the meninges
- More common in women
- Most commonly detected primary intracranial neoplasms
- Most sporadic but may be familial
- Associated with NF2 (22q) and MEN1 (also on 22q)
- Intracranial meningiomas cause raised ICP which can cause papilloedema
- Can arise from olfactory groove, sphenoid, optic nerve...
Presentation
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Painless, slow growing
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Visual loss
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Optic atrophy
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VIth nerve palsies: false localising sign
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Temporal fullness (sphenoid wing)
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Ophthalmoplegia
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Late proptosis (axial)
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Optociliary shunt: compression of the central retinal artery leads to blood flow shunting through the ciliary vessels
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Growth is accelerated during pregnancy
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Tumours are much more aggressive in younger patients
Histopathology
- Psammoma bodies (round calcific collections)
- Intranuclear cytoplasmic inclusions
Hot Topic
Imaging in optic nerve meningioma
- MRI can usually distinguish from other lesions eg glioma
- Classically reveals 'tram-tracking' sign: parallel thickening and enhancement of the nerve
- CT scan: sphenoid bone hyperostosis
Management
- Conservative: observation if vision is good
- Surgical excision: usually cannot be done without iatrogenic harm to vision, so reserved for cases where vision is poor/blind
- Radiotherapy