Rudd George, Aftahy Amir Kaywan, Meyer Bernhard, Wostrack Maria
Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Germany.
J Neurosurg Case Lessons. 2025 Jun 30;9(26). doi: 10.3171/CASE25156.
In this case report, the authors discuss the diagnosis and treatment of a rare primary optic nerve sheath schwannoma (ONSS). Typically, intracranial schwannomas arise from the vestibular division of cranial nerve VIII and seldom cranial nerves V and VII. This case underscores the need for further documentation of ONSS to better understand its origins, refine diagnostic approaches, and optimize management strategies to enable earlier detection and better outcomes for patients' vision.
The authors present the case of a 36-year-old patient who presented via an ophthalmologist due to visual loss in the left eye. She was initially treated for optic neuritis before further deterioration prompted repeat imaging, demonstrating a left extraorbital lesion distal to the optic chiasm. The patient underwent a complete resection of the lesion via pterional craniotomy in July 2024.
The authors report the 17th case of ONSS in the literature. Despite the optic nerve's usual myelination pattern, these tumors can form, likely originating from ectopic Schwann cells or perioptic sympathetic fibers. Resection via a pterional approach enabled complete removal without postoperative complications. Because of the rarity of ONSS, further study is essential to enhance diagnosis, treatment, and surgical strategies. https://thejns.org/doi/10.3171/CASE25156.
在本病例报告中，作者讨论了一种罕见的原发性视神经鞘膜瘤（ONSS）的诊断和治疗。通常，颅内神经鞘瘤起源于颅神经VIII的前庭分支，很少起源于颅神经V和VII。本病例强调需要进一步记录ONSS，以更好地了解其起源，完善诊断方法，并优化管理策略，从而实现对患者视力的早期检测和更好的治疗效果。
作者介绍了一名36岁患者的病例，该患者因左眼视力丧失经眼科医生转诊。她最初被诊断为视神经炎并接受治疗，随后病情进一步恶化促使再次进行影像学检查，结果显示在视交叉远端有一个左侧眶外病变。该患者于2024年7月通过翼点开颅术对病变进行了完整切除。
作者报告了文献中第17例ONSS病例。尽管视神经通常有其特定的髓鞘形成模式，但这些肿瘤仍可能形成，可能起源于异位雪旺细胞或视神经周围的交感神经纤维。通过翼点入路进行切除能够完整切除肿瘤且无术后并发症。由于ONSS罕见，进一步研究对于提高诊断、治疗和手术策略至关重要。https://thejns.org/doi/10.3171/CASE25156
