Bilateral occipital metastases: Visual deficits and management considerations

Abstract

Background: Metastases to the bilateral occipital lobes pose a difficult clinical scenario due to risk of debilitating visual loss. We sought to characterize clinical outcomes following different treatment modalities to help guide management in this challenging situation. Methods: We retrospectively reviewed brain metastases patients treated at a single institution between 2008 and 2017 and assessed visual symptoms before and after treatment, the tumor and peritumoral edema volumes before treatment, and clinical outcomes including mortality. Results: Eighteen patients with metastases affecting both occipital lobes were identified. Lung cancer represented the most common primary (n = 10). Visual deficits were present in 12 patients at the time of diagnosis of bilateral occipital metastases (67%). Patients received radiotherapy (n = 5) or combined surgical resection and radiotherapy (n = 13). Among symptomatic patients, two received radiation and 10 received combined surgery and radiation. Nine patients had improved visual symptoms after treatment with no new visual deficits reported as a result of treatment. Among asymptomatic patients, three were treated with radiation alone and three with resection and radiation. Three of these patients developed new visual symptoms following treatment, including one patient with Balint’s syndrome. Conclusion: Patients with symptomatic bilateral occipital lobe metastases may experience visual improvement following intervention, especially if symptoms stem from compression or edema. Those without visual symptoms are at risk of developing new visual deficits during treatment, which should be included in the decision-making process and when counseling patients. Visual deficits improved after surgery in the majority of patients, with no cases of immediate visual deterioration.

Case Report: Atypical visual presentation caused by a large convexity meningioma—a nerve stretching and stalk indentation effect

“…Xiao et al reported improvement in visual symptoms and papilledema in patients with ventriculomegaly after surgical treatment with ventriculostomy to relieve the IICP ( 19 ). In addition, visual symptoms improved in 70% of the patients with occipital lobe metastasis after a combination of surgery and radiation therapy ( 20 ). Galal et al identified indicators that predict a better visual outcome post-operatively, including duration of symptoms less than 1 year, partial visual deficits, tumor size less than 3 cm in maximum diameter, and a lesser degree of stretch and compression of the optic apparatus ( 17 ).…”