Dear Dr Adeleye, I will ask for CT images
I agree with you, the doctors have gone to great pains to produce these video renditions of the MRI
I agree wtih your differentials. Thank you for looking at the films.
I am concerned though about the lesions within the posterior ethmoids. They appear to be extending medially into the orbital apex/ chiasm on the left and I think that is the possible site of optic nerve compression responsible for the vision loss in the left eye.
Either optic nerve compression from optic canal involvement or compression at the junction of the chiasm and left optic nerve may be the case in this patient
It appears the posterior segment of the right optic nerve is not visualised in these films, if these are post op films, I wonder if this is the portio of the optic nerve that was excised and why this was done still remains a mystery to me because the major pathology is quite grossly evident and it is the floor, medial and lateral orbital walls in the right orbital apex (likely the body and wings of the sphenoid bone, trabeculae of the posterior ethmoid sinus or the meninges of the adjacent temporal or frontal lobes)
The mass in the posterior ethmoid may be part of the dysplastic bone or an associated mucocoele, its difficult to tell but a CT would help to delineate the bony margins
Nevertheless it is obvious this patient needs urgent surgery to remove some of the bony tumour impinging on the left orbital apex
Thank you for a wonderful job getting us these MRI scans in video format, using your camcorder was an ingenius idea!
Please could we have CT images if possible?
As this patient has lost vision completely (including part of her optic nerve) on the right, the focus should be trying to prevent complete vision loss on the left
If she is treated before irreversible blindness ensues, perhaps in the best case scenario she may regain vision to 6/60 on the left or some degree of mobility vision her field will be very limited though
As for the right side, the proptosis is quite modest and is enough to compromise vision from either anterior segment complications like exposure keratopathy or vascular compromise or even compressive or tractional optic nerve damage. I would assume the cornea was not severely affected since it was possible to see the right optic nerve and the palor at her initial visit but I do not know how it looks now Never the less, vision is not redeemable on the right
Please note: Summary of our thoughts...
- Vision is iredeemably lost on the right
- Focus should be shifted to protecting/ even remotely possible restoring vision LE
- Films suggest obvious compression at orbital apex on the right with a suggestion of infilteration into the left orbital apex medially across the midline likely from the posterior ethmoids or sphenoid
- Can the ENT surgeons exclude an underlying/accompanying posterior ethmoid mucocoele, if this can be removed and part of the medial wall of the optic canal, this may relieve pressure on the nerve?
- If you can send the CT images, we may be able to better define the mass lesion we are observing at the skull base
- LASTLY!!!!!!!! impress upon this patient the need to maintain her management where all her investigations and medical information is to avoid another mishap like the previous removal of her optic nerve and no histology!!!!!!!!
Thanks for the opportunity to contributeFunmi OGUN
From: Amos&Doyin ADELEYE <femdoy@...>
To: funmi Ogun <olufunmiogun@...>
Sent: Tue, March 22, 2011 6:53:22 PM
Subject: Re: Fw: Fibrous dysplasia Video attachments
These doctors must have gone through great pains to produce the images and they should be commended. It seems to me we have some ramifying sphenoorbital lesion of the skull base here worse to the right. differentials: meningioma en plaque, some skull base inflammatory/pseudo inflammatory conditions (there are many of them) or fibrous dysplasia as has been suggested. Unfortunately we did also to see cranial CT of this patient to be able to decide it is the latter: fibrous dysplasia. Are they able to produce CT images also?
Thanks for involving me here.
Dr. Amos Olufemi ADELEYE
Lecturer and Consultant Neurosurgeon
Department of Neurological Surgery
University College Hospital, UCH
PMB 5116, Ibadan 200001
+234 7038476183 and +234 7028462539
Olufemi, Doyin and Aanu: As for me and my household, we live by, and, for God in the Lord Jesus, the Christ. How
--- On Tue, 3/22/11, funmi Ogun <olufunmiogun@...> wrote:
From: funmi Ogun <olufunmiogun@...>
Subject: Fw: Fibrous dysplasia Video attachments
To: "Amos Adeleye" <femdoy@...>
Date: Tuesday, March 22, 2011, 6:35 PM
Dear Dr Adeleye,
We asked for images.
They are here
I will look at these and see what I can make of it.
Please help do the same
There are 3 such emails, I will forward all.
----- Forwarded Message ----
From: Dr. E . B . Chibuga <ebchib@...>
Sent: Tue, March 22, 2011 9:04:29 AM
Subject: Fibrous dysplasia Video attachments
Thank you very much for your contribution on our fibrous dysplasia
You have enlighten our mind and decision to be made.
Just go through these MRI video attachments for further analysis