Optic Nerve Glioblastoma with Optic Chiasm Involvement: A Case Report and a Brief Literature Review

Abstract

Background: optic nerve glioblastoma is an uncommon pathology. The optic chiasm, optic tract, or optic nerves are possible places from which the tumor can originate. Most of the neuroimaging findings are nonspecific. To confirm the diagnosis, a biopsy is required. A delay to the treatment plan for optic nerve glioblastoma results in poor patient survival rates. Case report: a 68-year-old woman with an uncomplicated medical history presented with exophthalmos, deteriorating eyesight, and partial loss of vision. Using radiological data together with postoperative histopathological and histochemical analysis, optic nerve glioblastoma, IDH-wildtype, with optic chiasm involvement was diagnosed. Conclusion: optic nerve glioblastoma is a rare and aggressive form of cancer that affects the optic nerve, leading to significant vision impairment and potentially life-threatening complications. Treatment options are restricted and difficult because of the location and nature of the condition; surgery, radiation therapy, and chemotherapy are frequently needed as part of a multidisciplinary approach.

Keywords: neurosurgery; ophthalmology; optic nerve glioblastoma; radiology.

Figure 1

Ocular ultrasound of the left eye showing a centrally located retrobulbar tissue echo signal mass, measuring about 1.3 cm × 1.4 cm.

Figure 2

(A) Optical coherence tomography of both eyes, showing a flattened thinner retina around the macular area in the left eye. (B) Retinal nerve fiber layer (RNFL) analysis of both eyes, revealing a reduced retinal nerve fiber layer in all left eye’s quadrants. (C) Ganglion cell layer (GCL) measurement showing asymmetry in both eyes, indicating ganglion cell damage in the left eye.

Figure 3

(A) CT scan of orbits, sagittal plane, 2 mm slice, showing a homogeneous, well-marginated optical nerve tumor with a mass effect and a compression of the rectus muscles of the eye (red arrows). (B) CT scan of orbits, axial plane, 1.25 mm slice, showing an intraconal lesion with intracranial extension, mass effect (blue arrow), and small calcification (green arrow). A mild exophthalmos can also be noted.

Figure 4

(A) MRI image, T1 VIBE fat-saturated post-gadolinium image sequence, axial plane, demonstrating an intraconal tumor which most likely originated from the optic nerve with intraconal and intracranial involvement, cystic changes (red arrows), and contrast enhancement (white circle). The intracranial compartment involves the optic chiasm with a mass effect on the surrounding structures and large blood vessels (red circle). (B) MRI image, T2 TSE Dixon sequence, coronal plane, showing both solid and cystic parts of the optic nerve tumor with a retrobulbar segment mass effect and extraocular muscle suppression (green circle).

Figure 5

Surgical microscope view of the surgical site.

Figure 6

The tumorous tissue extracted during the surgery.

Figure 7

Microscopic image of histopathological analysis, showing spherical cells with pronounced nuclear polymorphism, multinucleated tumor cells, and an area of vascular proliferation.

Figure 8

(A) MRI image, T2 TSE STRI sequence, of the aftermath of the left-sided pterional craniotomy, showing postsurgical edema (red arrow) with a small hemorrhagic component (blue arrow). Postsurgical changes in the intraconal space can also be noted, showing an edema and a hemorrhage (white circle). (B) MRI image, T1 vibe post-gadolinium image sequence, showing postsurgical changes in the region of the optic chiasm with partial (subtotal) tumor resection (red circle). Local brain edema with hemorrhagic component (green arrow) can also be noted.