시신경유두오목을 동반한 시신경수막류
Optic Nerve Sheath Meningocele with Optic Disc Pit
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초록
목적: 시신경수막류는 드문 질환으로 시신경을 압박하는 경우 시기능이 떨어질 수 있다. 시신경유두오목을 동반한 시신경수막류 1예에서 시신경집감압술을 시행하고 이를 보고하고자 한다. 증례요약: 15개월 남아가 우연히 발견된 좌안의 안와종양을 주소로 내원하였다. 안구돌출이나 구심동공장애는 없었고 안저검사상 좌안에 시신경유두오목이 관찰되었다. 자기공명영상에서 추체내에 약 13.5 x 12.7 mm의 뇌척수액과 동일 강도의 낭종이 발견되었다. 시신경은 낭종에 의해 하비측으로 전위되고 납작하게 눌려 있었다. 시신경유두오목을 동반한 시신경수막류로 진단하고 시신경 압박의 가능성을 우려하여 전신마취하에 시신경집감압술을 시행하였다. 수술 후 자기공명영상에서 시신경수막류는 약 11.7 x 10.9 mm로 줄었으며 눌려 있던 시신경 음영이 회복되었다. 그러나 수술 10개월 후 자기공명영상에서 수막류는 수술 전과 거의 비슷한 크기로 복원되었다. 결론: 저자들은 국내에서 보고된 바 없는 시신경유두오목을 동반한 시신경수막류를 경험하고 시신경집감압술을 시행하였으나 자기공명영상으로 관찰된 효과는 일시적이었으며, 시신경 기능이 악화되는지에 대한 지속적인 관찰이 요구될 것으로 생각되어 이를 보고하는 바이다.
Abstract
Purpose: Optic nerve sheath meningocele is a very rare condition; if the optic nerve is pressed, visual function can deteriorate. We report a patient with optic nerve sheath meningocele treated with optic nerve sheath fenestration. Case summary: We report a 15-month-old male who visited the outpatient clinic due to an orbital tumor in the left eye found by accident. He had no proptosis or relative afferent pupillary defect, and fundus examination revealed a left optic disc pit. On fat-suppressed magnetic resonance imaging (MRI), there was a well-defined 13.5 × 12.7 mm cystic lesion located at the superotemporal aspect of the left optic nerve within the optic nerve sheath. The optic nerve was compressed and displaced inferomedially. Once the diagnosis had been confirmed as optic nerve sheath meningocele, optic nerve sheath fenestration was performed under general anesthesia to relieve optic nerve compression. The compressed left optic disc returned to normal after surgery and the size of the meningocele shrunk to 11.7 × 10.9 mm on MRI. However, it re-expanded to almost the same size as that preoperatively 10 months later. Conclusions: We report a case of optic nerve sheath meningocele with an optic disc pit treated with optic nerve sheath fenestration, which has not been reported previously in the Republic of Korea. Because the effect of optic nerve sheath fenestration could be temporary, it is necessary to conduct regular checkups given the possibility of deterioration of visual function.
참고문헌 (15)
- Shanmuganathan V, "Bilateral idopathic optic nerve sheath meningocele associated with unilateral transient cystoid macular oedema", Eye(Lond), 16, pp.800~802 (2002)
- Garrity JA, "Optic nerve sheath meningoceles. Clinical and radiographic features in 13 cases with a review of the literature", Ophthalmology, 97, pp.1519~1531 (1990)
- Bane WC, "Cyst of dural sheath of optic nerve", Am J Ophthalmol, 65, pp.17~20 (1968)
- Killer HE, "The optic nerve: a new window into cerebrospinal fluid composition?", Brain, 129(Pt 4), pp.1027~1030 (2006)
- Lunardi P, "Surgically verified case of optic sheath nerve meningocele : case report with review of the literature", Neurosurg Rev, 20, pp.201~205 (1997)
- Lövblad KO, "Dural ectasia of the optic nerve sheath in neurofibromatosis type 1 : CT and MR features", J Comput Assist Tomogr, 18, pp.728~730 (1994)
- Mesa-Gutiérrez JC, "Optic nerve sheath meningocele", Clin Ophthalmol, 2, pp.661~668 (2008)
- Mahatma G, "Stabilization of visual function after optic nerve sheath fenestration for optic nerve meningocele", Ophthalmic Plast Reconstr Surg, 33, pp.e160~e161 (2017)
- Dailey RA, "The natural history and CT appearance of acquired hyperopia with choroidal folds", Ophthalmol, 93, pp.1336~1342 (1986)
- Dai Woo Kim, "Unilateral Optic Nerve Sheath Meningocele Presented With Amblyopia", Journal of Pediatric Ophthalmology & Strabismus (2011), SLACK, Inc[DOI]
- Bakbak B, "Dural ectasia of the optic nerve sheath: is it always benign?", Eye Brain, 1, pp.5~7 (2009)
- Ravi M, "Endoscopic management of optic nerve sheath meningocele", Clin Rhinology, 2, pp.63~65 (2009)
- Huang TL, "Optical coherence tomography of a coexisting optic nerve cyst and optic disc pit : a case report", Kaohsiung J Med Sci, 26, pp.261~265 (2010)
- Lally SE, "Optic nerve sheath meningocele simulating an optic nerve pit", Ophthalmic Plast Reconstr Surg, 34, pp.e138~ (2018)
- Georgalas I, "Optic disc pit : a review", Graefes Arch Clin Exp Ophthalmol, 249, pp.1113~1122 (2011)