Non-Syndromic Optic Chiasm Mass in an Adult
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Non-Syndromic Non-Syndromic Optic Chiasm Mass Optic Chiasm Mass in an Adult in an Adult Gaurav Gupta, M.Sc. Gaurav Gupta, M.Sc. Stanford University School of Stanford University School of Medicine Medicine MGH Neurosurgery MGH Neurosurgery Subinternship Subinternship September 23, 2010 September 23, 2010
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Non-Syndromic Optic Chiasm Mass in an Adult. Gaurav Gupta, M.Sc. Stanford University School of Medicine MGH Neurosurgery Subinternship September 23, 2010. Case Presentation. ID: 42 yo M with optic chiasm mass - PowerPoint PPT Presentation
Transcript of Non-Syndromic Optic Chiasm Mass in an Adult
Non-Syndromic Non-Syndromic Optic Chiasm Mass Optic Chiasm Mass
in an Adultin an AdultGaurav Gupta, M.Sc.Gaurav Gupta, M.Sc.
Stanford University School of Stanford University School of MedicineMedicine
MGH Neurosurgery MGH Neurosurgery SubinternshipSubinternship
September 23, 2010September 23, 2010
Case Presentation ID: 42 yo M with optic chiasm mass HPI: 40 lb weight loss over 6 months; loss
of libido, fatigue, polydipsia/polyuria X 4 months; blurred vision X 6 weeks
No significant PMH, no medications, FH/SH noncontributory
No history of radiation MRI 2005: “partially empty sella”, no
other abnormalities Exam: Dense bitemporal hemianopsia
Work-up and Differential Diagnosis
Primary glial neoplasm Germ cell tumor Primary CNS lymphoma Metastasis of unknown primary Isolated inflammatory process (e.g.
neurosarcoidosis)
NF1: Age at Diagnosis
Dermatology. 2008;216(4):347-8.
J Clin Neurosci. 2007 May;14(5):502-5.
Germ Cell Tumor
J Neurooncol. 2009 Dec;95(3):437-43.
Surgical Approaches
Minimally invasive Extended endoscopic endonasal Endoscopic transventricular
Open Pterional Transorbital/subfrontal Subfrontal
Extended Endoscopic Endonasal
Adv Tech Stand Neurosurg. 2008;33:151-99
Endoscopic Transventricular
J Neurosurg. 2010 Aug 13.
ETV
Medlock and Scott. Pediatr Neurosurg. 1997 Sep;27(3):129-36.
Craniotomy for Optic Chiasm Malignancy
Gross Appearance at Biopsy
Pathology
In initial stain of tissue samples, < 50% of cells took up GFAP, CD45, p53, Ki-67, IDH-1, and CD68
These will be re-stained along with PLAP (placental alkaline phosphatase), Oct4, c-kit/CD117
Emerging Diagnostic Modalities
PET-CT co-registered with MR spectroscopy Increase in SUV and choline/creatine ratio
distinguish high-grade from low-grade optic glioma in NF1 patients (Clin Nucl Med. 2010 Oct;35(10):838-9.)
3.0T DTI Optic gliomas may be detected by decreases in
fractional anisotropy (J Magn Reson Imaging. 2010 Jul;32(1):76-81.)
Dynamic contrast-enhanced (DCE) MRI Clinically aggressive optic gliomas have
significantly higher mean permeability values (Pediatr Radiol. 2008 38:1293–1299)
Questions
