Case Detail

History: (Dr Gharibdoost, Radiation-Oncologist:) A 50 years old woman presented 9 months ago with visual loss in the left eye. She underwent surgery using pterional approach. Visual condition was not improved and after 8 months was deteriorated. The first neurosurgeon has referred the patient for radiotherapy. According to the preoperative and the last MRIs, what is the best management? Reoperation or Radiation? If radiation is your preference, what technique do you suggest?

Question: Treatment Plan?

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Name	Date	Opinion	Result
Mousareza Anbarlouei	8/26/2021	I believe total resection is achievable	Surgery
Masoumeh Najafi	8/26/2021	First I consult with a neurosugeon, if the tumor is not resectable, i will do radiation therapy. Then, my suggestion is fractionated radiotherapy(Because tumor is touching the chiasma) dose 50 to 54Gy.	Surgery
Sara Soltanzadeh	8/27/2021	According to the deterioration of visual status in a short time, she would probably benefit more from surgical intervention. (radiation takes time to take effect and it can even make the clinical situation worse at the beginning). So, attempting complete surgical resection as the first approach, seems more rational. In the case of incomplete resection or high grade tumor(that we can somehow consider in this case due to the clinical history), post op radiation would be recommended. Regarding radiation techniques, since the tumor is in close proximity to the chiasma, SRS would be associated with more risks. Thus, other techniques like 3DCRT or FSRT are better suited in this case.	Surgery and Adjuvant treatment
Dr Sotoudeh	8/27/2021	If complete resection is possible, surgery is preferred. If not, radiation therapy with 3D conformal technique is a reasonable choice.	Surgery
Sara rast	8/27/2021	Surgery is first choice if possible , radiotherapy is second choice where surgery cant be done. Sbrt imrt or 3d total 50.40-5400	Surgery
Amin Jahanbakhshi	8/27/2021	I think it is a remnant tumor rather than a recurrence. I prefer to perform repeat surgery as soon as possible. Radiotherapy has no role in the context of deteriorating vision and need for urgent intervention.	Surgery
Dr Hassani	8/27/2021	Surgical decompression is a good choice foe this patient.	Surgery
Keyvan Tayebi Meybodi	8/27/2021	Based on the available images, I cannot decide whether the tumor has engulfed the left optic nerve or not. The history is not informative regarding the type of visual loss. Physical exam and perimetry is not available. There is no non-contrast enhanced high-resolution T1 image to show if there is optic nerve engulfment in the optic canal, or not. I wonder, why the first surgeon has approached to the tumor from the right side, since the visual problem is detected on the left. It seems that after 8 months, there is tumor infiltration in the left cavernous sinus. This must be confirmed with the additional images. Supposing the left-side visual deterioration is due to optic nerve compression, surgery (either open[ pterional], or endoscopic) may be helpful. More sophisticated diagnostic measures may help us.	Surgery