Papilloedema from Dural Venous Sinus Compression by Meningiomas

Abstract

Intracranial mass lesions may cause intracranial hypertension secondary to venous hypertension when they compress the dural venous sinuses (DVS) and may present with isolated papilloedema, mimicking idiopathic intracranial hypertension. We report a series of 16 patients with isolated papilloedema related to meningiomas compressing the DVS seen from 2012 to 2016 at three institutions. Correct diagnosis was delayed in 10/16 patients and treatment required a multidisciplinary approach, often with multiple sequential interventions, including combinations of acetazolamide, cerebrospinal fluid-shunt, optic nerve sheath fenestration, surgical resection of the meningioma, radiation therapy, and endovascular venous stenting. Two patients also received anticoagulation for venous thrombosis secondary to venous sinus compression.

Tumor recurrence in parasagittal and falcine atypical meningiomas invading the superior sagittal sinus

“…The tumor volume was higher than the median tumor volume in all three cases. Also, in all three patients, the SSS was invaded by the tumor, which confirms the literature correlations between dural sinuses invasion and intracranial hypertension syndrome [93,94,95].…”

“…Papilledema is another clinical element specific to the intracranial meningioma pathology. Therefore, literature studies have proven that meningiomas that involve the major dural sinuses can impede on cerebral venous outflow, which results in venous and intracranial hypertension, with subsequent decreased resorption of the cerebrospinal fluid [ 92 , 93 ]. In our group of patients, papilledema occurred in three patients (one woman and two men), with an intracranial hypertension syndrome on admission.…”

Diagnostic Error in Neuro-ophthalmology: Avenues to Improve

“…Prior studies on diagnostic error in neuro-ophthalmology have been limited (Table 1 ). Studies have been primarily descriptive [ 13 , 14 , 16 – 18 , 21 , 22 , 23 •, 24 •, 25 ], almost exclusively retrospective [ 13 , 16 – 18 , 21 , 23 •, 24 •], and mostly limited in scope—either to a single condition [ 13 , 16 – 18 , 24 •, 26 ] and/or a single institution [ 13 , 14 , 16 – 18 , 21 , 23 •]. Prior studies including multiple neuro-ophthalmic conditions found misdiagnosis rates up to 69% prior to neuro-ophthalmology consultation [ 14 , 23 •].…”

“…Similarly high rates of misdiagnosis have been seen in prior studies focusing on a single neuro-ophthalmic condition—up to 60% for optic neuritis [ 13 ] and 71% for optic nerve sheath meningiomas [ 18 ]. Several studies attempted to identify the cause of these diagnostic errors, and common themes were inadequate history [ 13 , 16 , 17 , 22 ], inaccurate performance of the physical examination or inaccurate interpretation of the examination findings [ 13 , 17 , 24 •], failure to obtain appropriate imaging to answer the clinical question [ 14 , 22 , 25 ], incorrect interpretation of imaging findings [ 13 , 14 , 16 , 17 , 21 , 22 , 23 •, 25 ], and generation of a flawed or incomplete differential diagnosis [ 13 , 22 ].…”

“…Most errors were due to inaccurate weighing of differential or inaccurate examination Blanch et al, 2019 [ 26 ] Prospective cohort study 198 patients Papilledema Misdiagnosis rate for papilledema using fundus photographs 21% Sensitivity was close to 100% across all specialties (neuro-ophthalmology, neurology, ophthalmology and emergency medicine). Specificity ranged from 43–100% depending on specialty Hartmann et al, 2019 [ 25 ] Retrospective review 16 patients Intracranial hypertension due to compression of dural venous sinus by meningioma Delayed diagnosis 63% 40% had a poor visual outcome in the setting of delayed diagnosis. Most errors were due to misinterpretation of or failure to obtain sufficient imaging Kahraman-Koytak et al, 2019 [ 18 ] Retrospective review 35 patients Optic nerve sheath meningioma Misdiagnosis rate and causes 71% 64% had a poor visual outcome in the setting of delayed diagnosis.…”