Guhlmann M, Kommerell G
Abteilung Neuroophthalmologie und Schielbehandlung, Universitäts-Augenklinik Freiburg.
Klin Monbl Augenheilkd. 1995 Sep;207(3):200-2. doi: 10.1055/s-2008-1035368.
The optic nerve sheath meningioma usually presents with a diffuse atrophy of the disc and a diffuse depression of the visual field. Applying this rule too rigidly can lead to a false diagnosis.
A 45y-old-woman presented with atrophy of the upper disc and a corresponding altitudinal field defect in her right eye. AION was diagnosed. Seventeen years later the patient returned with an exophthalmus. The disc was atrophic and a shunt vessel connected the central retinal vein with the choroid. CT revealed an orbital mass. The diagnosis of an optic nerve sheath meningioma was made and confirmed at surgery.
The meningioma may have occluded an upper posterior ciliary artery, mimiking an AION. Alternatively, the meningioma may have destroyed the fibers running through the upper half of the disc and caused swelling of the remaining fibers in the lower half of the disc.
In the combination of swelling and atrophy of one disc an optic nerve sheath meningioma should be considered, even if the two components are located in different sectors. In optic nerve sheath meningioma vision decreases insidiously as opposed to the acute drop typical for anterior ischemic optic atrophy.
视神经鞘膜瘤通常表现为视盘弥漫性萎缩和视野弥漫性缺损。过于严格地应用这一规律可能导致误诊。
一名45岁女性，右眼视盘上部萎缩并伴有相应的象限性视野缺损，诊断为前部缺血性视神经病变（AION）。17年后，患者因眼球突出复诊。视盘萎缩，一条分流血管连接视网膜中央静脉和脉络膜。CT显示眶内有肿块，诊断为视神经鞘膜瘤，并经手术证实。
脑膜瘤可能阻塞了睫状后上动脉，酷似前部缺血性视神经病变。或者，脑膜瘤可能破坏了穿过视盘上半部分的纤维，并导致视盘下半部分其余纤维肿胀。
即使视盘肿胀和萎缩这两个部分位于不同区域，当一个视盘同时出现肿胀和萎缩时，也应考虑视神经鞘膜瘤。与前部缺血性视神经萎缩典型的急性视力下降不同，视神经鞘膜瘤导致的视力下降较为隐匿。
