PMC4926538_01
(a) Contrast-enhanced axial magnetic resonance imaging (MRI) before operation shows the inner-third sphenoid wing meningioma. (b) Contrast-enhanced coronal MRI before operation shows tumor invasion into the optic canal (arrow: Optic canal invasion). (c) The anterior clinoid process was removed, and optic canal decompression was performed. (d) The tumor component around the optic nerve was removed as much as possible. However, the optic nerve had already become thin and slightly atrophic. (e) CT scanning after operation shows 95% removal of the inner-third sphenoid wing meningioma
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F1
In addition, the lesion was attached to the lateral wall of the cavernous sinus, anterior clinoid process, and frontal skull base [Figure 1a]. MRI showed tumor invasion to the left optic canal [Figure 1b]. MR angiography showed middle meningeal artery as the feeding artery. Then, the left anterior clinoid process was removed, and optic canal decompression was performed by an extradural approach [Figure 1c]. Enough decompression of the optic nerve was achieved [Figure 1d] with Simpson's grade 3 removal of the tumor. Subtotal resection (95% removal) of the tumor was confirmed by postoperative CT images [Figure 1e].
(a) Postoperative examination of the visual field shows improvement of the lateral side of her left eye 11 days later. (b) Postoperative examination of the visual field shows further improvement of her left eye 2 months later. However, a scotoma near the center remained
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F2
Her visual field had further improved 11 days after surgery [Figure 2a]. Left visual acuity and her visual field had improved even further 2 months after the surgery [Figure 2b].