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Thomas Ableman, Steven A Newman; Proper ordering and interpretation of studies to avoid diagnostic delay in optic nerve sheath meningioma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3866.
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Optic nerve sheath meningiomas are often discovered after substantial delay. The fact that fractionated radiation therapy may substantially improve the prognosis underlies the importance of timely diagnosis and treatment. We performed a retrospective analysis of 7 cases of optic nerve sheath meningiomas with substantial diagnostic delay to identify the circumstances and pitfalls which led to the delay.
Retrospective analysis of 7 cases of optic nerve sheath meningiomas with substantial diagnostic delay including records, imaging, and diagnostic studies
In several cases significant progressive visual loss occurred during the 1-10 year delay in diagnosis. Some of these reversed with radiation therapy after definitive diagnosis and referral to the interventional radiology service. : Four potentially preventable problems resulting in diagnostic delay were identified:<br /> 1. Lack of ordering imaging studies often due to an alternative diagnosis such as AION or papillitis.<br /> 2. Lack of appropriately directed imaging (head scans instead of orbital scans, the lack of employment of fat sat and gadolinium).<br /> 3. Miss-reading requiring reinterpretation.<br /> 4. Misinterpretation of OCT data because blocked axonal transport masks development of optic atrophy.
Advances in technology have improved our ability to identify potentially treatable optic nerve sheath meningiomas. However, it remains incumbent on the evaluating ophthalmologist to be familiar with appropriate ordering and interpretation of such studies to avoid diagnostic delay.
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