Case description

The patient is a 54-year-old female who was found to have a mild left superior nasal field cut on her annual visual examination. Brain magnetic resonance imaging (MRI) revealed a tuberculum sella meningioma causing mild mass effect on the optic tract/chiasm ( Figure 4.17.1 ). Since the patient did not have any subjective visual field deficits, stereotactic radiosurgery (SRS) was performed ( Figure 4.17.2 ).

Postcontrast axial, sagittal, and coronal images showing a 1.1 × 1.4 × 0.9 cm homogeneously enhancing mass in the suprasellar region exactly right of the midline, causing a mass effect on the optic tract/chiasm.

Imaging of the treatment plan.

Critical Structure	Dose Tolerance
Optic nerve/chiasm	25 max per 5 fractions / <0.2cc>20 Gy
Brainstem	31 max per 5 fractions / <1cc>26 Gy
Cranial nerves in cavernous sinus	Unknown but significantly more resistant than optic nerve Can be more sensitive if stereotactic radiosurgery (SRS) follows another form of radiation
Cavernous carotid artery	Very tolerant No evidence of SRS-induced stenosis

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