A 52-year-old female patient with no family history of cancer interest. She had been operated on for tunnel syndrome in her left hand and malignant mammary nodules.
At the time of diagnosis she was being treated with calcium supplements and calcitonin for osteoporosis.
Since November 1999 she noticed loss of vision in her left eye, with occasional eye pain and bilateral conjunctivitis.
Pathological examination revealed unilateral optic disc edema in the left eye.
There was no change in eye movements of both orbits.
The following complementary examinations were performed.
- Orbital CT: in the vertex of the left orbit and in close contact with the optic nerve, a 1 cm mass with a larger diameter of the intraconal location is visualized in a diffuse irregular non-contrast.
There was no evidence of enlargement of the optic hole or intracranial invasion; there were no bone erosions.
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- brain and orbital MRI: an isointense signal mass with the brain parenchyma in all sequences occupying the left optic hole and showing intense and homogeneous contrast uptake.
The lesion covered the left optic nerve, which was slightly compressed.
The approximate size of the lesion was 2x1x1 cm. The findings suggested the presence of meningioma although other possibilities could not be ruled out, such as a nerve sheath tumor.
Search strategy: visual acuity reduced visual acuity to 1/10 and visual field study showed a left eye deficit partially preserving internal upper quadrant vision.
Assessed by the Radiosurgery Committee (RC), the case was accepted for RTEF, irradiating with a Lineal Accelerator with photons of 6 Mv, with a total dose of 1.8 Gyro conical arches.
80% Coverage Isodose was chosen as reference.
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The patient responded clinically with the disappearance of painful orbital symptoms and exophthalmos in the first half-yearly control.
MRI examinations confirmed in the first control at six months a favorable evolution, with a significant decrease in tumor size, leaving areas of uptake around the optic hole, suggestive of posterior meninges of tumor remnants that have remained stable.
Pathological studies showed improvement of a certain degree of vision, a situation that has remained over time.
The patient was labeled in partial/complete clinical remission.
To date, no signs of optical toxicity have been reported.
