PMC6198069_01
Magnetic resonance imaging of the left orbit. The lesion essentially replaces the optic nerve (A,C,D), and has a component extending superiorly onto the left side of the planum sphenoidale (B).
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F1
Rather, the lesion essentially replaced the optic nerve and appeared to demonstrate infiltration into the nerve, which raised the suspicion for an optic nerve glioma (Figure 1). By virtue of dural involvement of the planum sphenoidale, this mass was suggestive of an atypical left ONSM, which had on some images apparently replaced the nerve (Figure 1).
68Ga -DOTATATE PET (C,D), fused with MRI in (A,D). The lesion shows conspicuous diffuse radiotracer uptake and maximum standardized uptake value of 10.8. There is a nearby but separate focus that localizes to the left aspect of the planum sphenoidale (B,D).
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F2
There was a nearby but separate focus of activity more superoposteriorly, which localized to the left aspect of the planum sphenoidale (Figure 2).
(a) Volumetric arc treatment plan of the patient described in this case report. This figure is showing representative cuts in the transverse (A), sagittal (B), and coronal (C) planes. (b) Tentative proton treatment plan of the patient described in this case report. This figure is showing representative cuts in the transverse (A), sagittal (B), and coronal (C) planes.
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F3
A VMAT radiation plan (Figure 3A) was chosen over a proton therapy plan (Figure 3B) because of improved dose conformity and target coverage in the former.
Magnetic resonance imaging of the left orbit 2 months (A) and 5 months (B) after treatment completion. The tumor is less enhancing than pre-treatment, its size is stable to slightly decreased, and "tram-tracking" is more apparent.
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F4
The meningioma on the 2- and 5-month follow-up MRIs was found to be less enhancing and its size was slightly decreased to stable (Figure 4), indicating good local control.