Presentation
Right-sided proptosis and blurring of vision
Patient Data
An extra-axial space-occupying lesion is noted based on the right sphenoid wing. The lesion displays an intermediate signal in both T1 and T2 WIs, and a high signal in FLAIR images. In the diffusion study, the lesion shows no diffusion restriction. Following contrast administration, it shows intense homogenous enhancement with enhancing dural tail. An associated mass effect is seen in the form of mild vasogenic edema and minimal effacement of the ipsilateral frontal horn of the lateral ventricle. The lesion shows intra-orbital extension through the optic canal compressing the optic nerve. Inside the orbit, it is seen in the extra-conal space. An associated hyperostosis of the right sphenoid wing and minimal forward displacement of the right eye globe are also noted.
Annotated images describing the tumor's extension and relations:
the intra-orbital extension of the tumor (white arrowhead) is seen compressing the optic nerve (yellow arrow)
the enhancing lesion based on the sphenoid wing (green arrowhead) is seen extending into the orbit through the optic canal (red arrowhead)
Case Discussion
Spheno-orbital meningiomas are difficult tumors to manage due to the post-operative risk of visual loss. The risk of visual loss may occur as a result of surgery or tumor progression. Hyperostosis, dural invasion and extension into the orbit through either the optic canal or the superior orbital fissure are all features of spheno-orbital meningioma.
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