title: [Delay in diagnosis of meningiomas involving the optic apparatus: conclusions and guidelines for early imaging based on our experience in 100 patients].
abstract: BACKGROUND
  Early diagnosis of tumors which compress the anterior optic apparatus is important in order to prevent visual functional damage. Pre-operative visual function is correlated with post operative visuaL results, therefore, delay in diagnosis leading to deterioration in vision may cause irreversible damage.
  
  
  OBJECTIVE
  Reviewing our experience with 100 patients with meningiomas involving the optic apparatus and establishing guidelines for early imaging in patients with visual impairment to prevent delays in diagnosis.
  
  
  METHODS
  Data was retrospectively collected for 100 patients with a meningioma involving the anterior optic apparatus, who underwent surgery between the years 2003-2011. Data was collected from hospital inpatient and outpatient files, as well as eye exams from the outset of the patient's symptoms and other exams that were carried out in the community.
  
  
  RESULTS
  In 14 patients there was a delay of one year or more in the diagnosis of meningioma. Of these, 3 were initially diagnosed with glaucoma, 3 with cataracts, 2 with migraines, in 5 patients no further investigation was conducted in spite of their ongoing complaints and in 1 patient, brain imaging was reported as normal.
  
  
  CONCLUSIONS
  In a distinct number of patients there was a delay in diagnosis of over a year. A patient with complaints of deterioration in visual acuity which is not corrected by glasses, with examination findings of an afferent pupil and visual field defects, should undergo neuro-imaging in order to rule out a space-occupying lesion. This should be the case even if the patient has findings of a cataract which may partially explain deterioration in visual acuity.
authors.affiliation: Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University. nevom@tasmc.health.gov.il
authors.forename: Nevo
authors.initials: N
authors.lastname: Margalit
authors.forename: Gal
authors.initials: G
authors.lastname: Barkay
authors.forename: Anat
authors.initials: A
authors.lastname: Kesler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000175:diagnosis / Q000209:etiology; D057210:Delayed Diagnosis; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000209:etiology; D009900:Optic Nerve / Q000473:pathology* / Q000601:surgery; D019574:Optic Nerve Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors