Cavernous Sinus Schwannoma
A 47-year-old male reported suffering from headache and diplopia for 10 years that has become worse in the most recent 2 years. He presented to the ophthalmology department because of sudden blurring in the left eye 1 month ago, which resolved spontaneously later. His vision was 6/5 with glass correction in both eyes. Anterior segments were unremarkable. Fundoscopic examination was normal (Fig. 49.1), and OCT revealed normal thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) over the macula. A visual field examination was normal except for small focal defects over the superior regions. However, an MRI revealed a 2 × 1 × 1.4 cm nodule in the anterior aspect of the left cavernous sinus extending to the left superior orbital fissure (Fig. 49.2). Hemangioma or meningioma in the cavernous sinus was suspected. After consultation, the patient decided to receive r-knife radiosurgery 1 month later. Three days after the radiosurgery, he reported experiencing blurriness in the left eye. Emergent ophthalmic consultation revealed decreased visual acuity of 6/60 with glass correction in the left. He could identify 15 plates in the right eye and 0 plate in the left with the Ishihara color test. Visual field testing revealed a dense central and inferotemporal scotoma in the left eye [Fig. 49.3]. Steroid pulse therapy was given to reduce tissue edema following the radiosurgery. His left vision recovered to 6/5 1 month after steroid treatment. Nonetheless, it progressed to hand motion under oral steroid 2 months later. He decided to undergo a craniotomy for removal of the tumor. The pathological report came back as a schwannoma of the cavernous sinus. His vision recovered to 6/6 with normal visual fields [Fig. 49.4] 6 weeks after the surgery.
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