scholarly journals Optic nerve sheath meningioma endoscopic endonasal surgical management

2020 ◽  
Vol 11 ◽  
pp. 90
Author(s):  
Igor Paredes ◽  
José Antonio Fernandez Alén ◽  
Alfredo García ◽  
Esther García ◽  
Alfonso Lagares
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Surgical Approaches ◽  
Case Description ◽  
Endoscopic Endonasal ◽  
The Poor ◽  
Nerve Sheath ◽  
First Case ◽  
Optic Nerve Sheath Meningioma

Background: Meningiomas of the optic sheath have been traditionally treated with radiotherapy, among other reasons, because of the poor results in terms of visual preservation of the open surgical approaches. Case Description: Two cases of optic nerve meningioma were operated through an endoscopic endonasal expanded approach due to rapidly progressing visual deterioration and doubtful diagnosis. In the first case an exclusively bone decompression was performed. In the second one a partial resection of the intradural portion and complete opening of the dural sheath was undertaken. In both cases visual acuity remained stable without further treatment for the 2 years follow up. Conclusions: Endoscopic endonasal decompression of the optic nerve by removal of the optic canal and opening of the optic sheath is safe. This approach is feasible for optic sheath meningioma. This treatment might be considered as an option in patients with rapidly deteriorating visual acuity.

Long-term efficacy of fractionated conformal radiotherapy for the management of primary optic nerve sheath meningioma

2018 ◽  
Vol 103 (10) ◽  
pp. 1436-1440 ◽  
Author(s):  
Ravi Pandit ◽  
Liliana Paris ◽  
Danielle S Rudich ◽  
Robert L Lesser ◽  
Mark J Kupersmith ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Symptom Onset ◽  
Conformal Radiotherapy ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
The Mean

Background/AimFractionated conformal radiotherapy (FCRT) is now used to treat vision-threatening optic nerve sheath meningioma (ONSM), but long-term efficacy and safety data are lacking; the purpose of this study was to assess these key data.MethodsThis is a retrospective chart review with prospective follow-up of adult patients treated with FCRT for primary ONSM at four academic medical centres between 1995 and 2007 with ≥10 years of follow-up after treatment.Results16 patients were identified with a mean post-treatment follow-up of 14.6 years (range: 10.5–20.7 years). The mean age at symptom onset was 47.6 years (range: 36–60 years). FCRT was performed at a mean of 2.3 years after symptom onset (range: 0.2–14.0 years). At last follow-up, visual acuity had improved or stabilised in 14 of the 16 (88%) patients, and 11 (69%) had retained or achieved ≥20/40. The mean deviation on automated perimetry remained stable (−14.5 dB pretreatment vs −12.2 dB at last follow-up; p=0.68, n=10). Two (11%) patients had persistent pain, proptosis or diplopia, compared with six (38%) pretreatment (p=0.11). Two (13%) patients developed radiation retinopathy more than 6 months after completion of therapy, one (50%) of whom had worse visual acuity compared with pretreatment. No patient developed tumour involvement or radiation damage in the fellow eye.ConclusionFCRT stabilises or improves visual function in patients with primary ONSM and is associated with a low risk of significant ocular sequelae. This treatment should be considered instead of surgery in patients with primary ONSM who require intervention due to loss of visual sensory and/or ocular motor function.

Giant Optic Nerve Cyst Not Associated to Optic Sheath Meningioma

1997 ◽  
Vol 10 (4) ◽  
pp. 471-474
Author(s):  
L. Manfrè ◽  
D. Monreale ◽  
R. Martino ◽  
C. Sarno
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
Slow Growing ◽  
Orbital Disease

Cystic enlargement of the optic nerve sheath is extremely rare and has been described in the literature in association with optic nerve meningioma. We describe MR findings over a 3.5 year follow-up in a patient with a large slow-growing retrobulbar ONC, not associated with optic nerve sheath meningioma or other optic nerve or orbital disease.

Progressive sixth nerve palsy secondary to intracavernous arachnoid cyst and complicated by contralateral optic nerve sheath meningioma

2019 ◽  
Vol 30 (5) ◽  
pp. NP86-NP89
Author(s):  
Kelly A Malloy ◽  
Erin M Draper ◽  
Ashley K Maglione ◽  
Kelly M Seidler
Keyword(s):  
Optic Nerve ◽  
Arachnoid Cyst ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Critical Role ◽  
Optic Nerve Sheath ◽  
Ocular Motility ◽  
Nerve Sheath ◽  
First Case ◽  
Optic Nerve Sheath Meningioma

Introduction: Optic nerve sheath meningiomas and intracavernous arachnoid cysts are both fairly rare conditions, and to the best of our knowledge, have not been previously reported to co-occur in the same patient. Both can cause diplopia, but only ONSMs have been documented to demonstrate progressive worsening of ocular motility. Case Report: A 67-year-old woman with blur and diplopia demonstrated a right optic neuropathy and limited ductions bilaterally. Neuroimaging revealed a right optic nerve sheath meningioma and left intracavernous arachnoid cyst. She was conservatively managed with neurosurgical surveillance for 1.5 years, until her diplopia worsened. Ocular motility re-evaluation demonstrated a worsening left abduction deficit, suggesting interval change of the intracavernous cyst, rather than the meningioma. Conclusion: There are only a few reported cases of cranial nerve VI palsy secondary to a cavernous sinus arachnoid cyst. However, this is the first reported case in a patient with a concurrent optic nerve sheath meningioma, and the first case demonstrating progressive worsening of a sixth cranial nerve palsy from an intracavernous arachnoid cyst. Determining which comorbidity caused worsening of symptoms played a critical role in the management of this patient.

Long-term results of Gamma Knife surgery for optic nerve sheath meningioma

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 28-33 ◽  
Author(s):  
Dong Liu ◽  
Desheng Xu ◽  
Zhiyuan Zhang ◽  
Yipei Zhang ◽  
Yanhe Li ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Optic Nerve Sheath ◽  
Long Term Results ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
The Mean

Object The goal of this study was to assess the long-term results of Gamma Knife surgery (GKS) in patients harboring an optic nerve sheath meningioma (ONSM). Methods Thirty patients harboring an ONSM were treated with GKS between 1998 and 2003. Gamma Knife surgery was performed as the sole treatment option in 21 of these patients and resection had been performed previously in 9 patients. The mean volume of the tumor at the time of GKS was 3.6 cm3 (range 1.4–9.7 cm3), and the mean prescription peripheral dose was 13.3 Gy (range 10–17 Gy). The mean number of isocenters used to treat these lesions was 8 (range 5–14 isocenters). Results At a median follow-up of 56 months, visual acuity improved in 11 patients, remained stable in 13 patients (including 4 patients who were completely blind before GKS), and deteriorated in 6 patients. Follow-up images were available in all patients and showed tumor regression in 20 patients and stable tumor in 8 patients. Persistent imaging evidence of progression was only present in 2 patients. With the exception of reversible conjunctival edema in 4 cases, no other serious acute side effect was observed. Conclusions Gamma Knife surgery provides long-term tumor control for ONSM. The results of this study add substantial evidence that GKS may definitely become a standard treatment approach in selected cases of ONSM.

Surgical treatment of progressive visual loss in traumatic optic neuropathy

1989 ◽  
Vol 70 (5) ◽  
pp. 799-801 ◽  
Author(s):  
John Guy ◽  
Mark Sherwood ◽  
Arthur L. Day
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Arachnoid Cyst ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Optic Nerve Sheath ◽  
Traumatic Optic Neuropathy ◽  
Axial Tomography ◽  
Nerve Sheath ◽  
First Case

✓ In two patients with traumatic optic neuropathy progressive visual loss was reversed by surgical decompression of the optic nerve sheath. The first patient with hemorrhage beneath the optic nerve sheath had progressive loss of vision from counting fingers to no light perception within 24 hours after the injury. Surgical evacuation of the hematoma improved visual acuity to 8/30. The second patient had progressive visual loss from 20/20 to 20/400 within the 1st week after injury. Drainage of an arachnoid cyst of the optic nerve sheath improved visual acuity to 20/25. Computerized axial tomography disclosed the hemorrhage in the first case and enlargement of the optic nerve sheath in the second. While the management of traumatic optic neuropathy is controversial, surgical intervention for an arachnoid cyst and hematoma involving the optic nerve is clearly beneficial.

Optic Nerve Sheath Meningioma: A Case Report with 15-Year Follow-Up

2013 ◽  
Vol 29 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Zeljka Vukovic Arar ◽  
Zoran Vatavuk ◽  
Blazenka Miskic ◽  
Zeljka Janjetovic ◽  
Sandra Sekelj ◽  
...  
Keyword(s):  
Case Report ◽  
Optic Nerve ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma

scholarly journals Prognostic factors in the surgical treatment of intracanalicular primary optic nerve sheath meningiomas

2019 ◽  
Vol 131 (2) ◽  
pp. 481-488 ◽  
Author(s):  
Marcio S. Rassi ◽  
Sashank Prasad ◽  
Anil Can ◽  
Svetlana Pravdenkova ◽  
Rami Almefty ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prognostic Factors ◽  
Surgical Treatment ◽  
Optic Nerve ◽  
Vision Loss ◽  
Tumor Resection ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Objective Evidence

OBJECTIVEAlthough meningiomas frequently involve the optic nerve, primary optic nerve sheath meningiomas (ONSMs) are rare, accounting for only 1% of all meningiomas. Given the high risk of vision loss with these tumors, surgical intervention is seldom considered, and radiation or observation is commonly applied. Here, the authors describe the visual outcomes for a series of patients who were treated with surgery aiming at maximal tumor resection and highlight their prognostic factors.METHODSThe authors retrospectively analyzed the data for 8 patients with intracanalicular ONSMs who had been surgically treated by the senior author (O.A.) between 1998 and 2016. Meningiomas extending into the optic canal from the intracranial cavity (i.e., clinoid, sphenoid wing, tuberculum sellae, diaphragma sellae) were excluded. Diagnosis was based on ophthalmological, radiological, and intraoperative findings, which were confirmed by the typical histological findings. Preoperative, postoperative, and follow-up visual assessments were performed by neuro-ophthalmologists in all cases.RESULTSThe patients included 7 females and 1 male. The mean age at diagnosis was 45.1 years (range 25.0–70.0 years). Mean duration of follow-up was 38.9 months (range 3.0–88.0 months). All patients reported visual complaints, and all had objective evidence of optic nerve dysfunction. Their evaluation included visual field, visual acuity, funduscopy, and retinal fiber thickness. Total resection was obtained in 4 cases. Comparing preoperative and postoperative visual function revealed that 4 patients had improvement at the last follow-up, 1 patient had stable vision, and 3 patients had decreased function but none had total vision loss. All patients with good preoperative visual acuity maintained this status following surgical treatment. There was no surgical mortality or infection. Operative complications included binocular diplopia in 4 patients, which remitted spontaneously.CONCLUSIONSSurgery can play a beneficial role in the primary treatment of ONSM, especially lesions located in the posterior third of the nerve. Total removal can be achieved with vision preservation or improvement, without major surgical complications, especially at early stages of the disease. Patients with good preoperative vision and CSF flow in the optic sheath have better chances of a favorable outcome than those with poor vision.

scholarly journals Arachnoid cyst of the optic nerve: therapeutic management and progress

2020 ◽  
Vol 17 (2) ◽  
pp. 137-141
Author(s):  
Irene Temblador-Barba ◽  
Carlos Gálvez-Prieto-Moreno ◽  
María Martínez-Jiménez
Keyword(s):  
Magnetic Resonance Imaging ◽  
Optic Nerve ◽  
Arachnoid Cyst ◽  
Visual Fields ◽  
Resonance Imaging ◽  
Transconjunctival Approach ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
Magnetic Resonance Imaging Mri

Purpose: To describe the management of a case of an arachnoid cyst of the optic nerve. Methods: Here, we report a 27-year-old female patient who was diagnosed with arachnoid cyst of the left sheath optic nerve, drained in several occasions, and came to our service because of progressive blurring in the left eye. Outcomes: Due to the location of the lesion, excision could not be performed; so we performed a microsurgical incision with drain by nasal superior transconjunctival approach. After that, the visual acuity (VA) was 0.7, and we could observe that the size of the cyst was smaller than previous examinations with magnetic resonance imaging (MRI). Nowadays, the patient keeps the same asymptomatic VA. So medical appointments are planned to closely follow-up, and periodically, we perform new scan images and visual fields. Conclusions: Arachnoid cysts of the optic nerve are rare, benign, slowly progressive conditions. They can be asymptomatic lesions, especially smaller ones, or may result in proptosis and loss of vision because of the compression. The best imaging examination for their follow-up is MRI. They should be differentiated from optic nerve sheath meningioma and other conditions.

scholarly journals Surgical Resection of an Optic Nerve Sheath Meningioma: Relevance of Endoscopic Endonasal Approaches to the Optic Canal

2017 ◽  
Vol 78 (02) ◽  
pp. e81-e85 ◽  
Author(s):  
Patrick Hunt ◽  
Franco DeMonte ◽  
Rosa Tang ◽  
Shirley Su ◽  
Shaan Raza
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Sheath ◽  
Optic Canal ◽  
Resonance Imaging ◽  
Blurred Vision ◽  
Endoscopic Endonasal ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma ◽  
History Of ◽  
Ophthalmologic Examination

AbstractOptic nerve sheath meningiomas (ONSMs) account for less than 2% of meningiomas and 1.7% of orbital tumors. Although rare, the management of these tumors is important as unilateral blindness often results in untreated cases. Radiotherapy has emerged as the preferred treatment. However, therapies for ONSMs are controversial due to the variable natural history of the disease and limitations of surgical and radiotherapy options. A 60-year-old woman presented with monocular left diminished color perception and blurred vision. Magnetic resonance imaging demonstrated a homogenously enhancing 5-mm left optic nerve mass with evidence of nerve compression. Conservative management was advised. However, 1 month after diagnosis her visual acuity deteriorated further. Because of the small focal location of the tumor within the optic canal, surgery was considered. Given the tumor's location inferomedial to the optic nerve, an endoscopic endonasal approach to the optic canal was performed. This patient recovered fully with resolution of visual symptoms immediately following surgery. Postoperative imaging 24 hours after surgery demonstrated gross total resection of the tumor; 1 year postoperatively the patient has a normal ophthalmologic examination. This report highlights the value of endoscopic endonasal approaches in the management of select optic canal pathology, otherwise inaccessible via transcranial approaches.

scholarly journals Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Franziska Eckert ◽  
Kerstin Clasen ◽  
Carina Kelbsch ◽  
Felix Tonagel ◽  
Benjamin Bender ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Field ◽  
Patient Selection ◽  
Visual Function ◽  
Radiation Treatment ◽  
Treatment Decision ◽  
Interdisciplinary Treatment ◽  
Nerve Sheath

Abstract Background As optic nerve sheath meningiomas (ONSM) are rare, there are no prospective studies. Our retrospective analysis focusses on a cohort of patients with uniform disease characteristics all treated with the same radiotherapy regimen. We describe treatment decision making, radiotherapy planning and detailed neuro-ophthalmological outcome of the patients. Methods 26 patients with unilateral ONSM extending only to the orbit and the optic canal were evaluated for neuro-ophthalmological outcome. Radiation treatment was planned in a simultaneous integrated boost approach to gross tumor volume (GTV) + 2 mm / 5 mm to 54 Gy / 51 Gy in 1.8 Gy / 1.7 Gy fractions. Follow-up was done by specialized neuro-ophthalmologists. Visual acuity and visual field defects were evaluated after therapy as well as during follow-up. Results Interdisciplinary treatment decision for patients with ONSM follows a rather complex decision tree. Radiation treatment planning (equivalent uniform dose (EUD), maximum dose to the optic nerve) improved with experience over time. With this patient selection visual acuity as well as visual field improved significantly at first follow-up after treatment. For visual acuity this also applied to patients with severe defects before treatment. Long term evaluation showed 16 patients with improved visual function, 6 were stable, in 4 patients visual function declined. Interdisciplinary case discussion rated the visual decline as radiation-associated in two patients. Conclusions With stringent patient selection radiotherapy for unilateral primary ONSM to 51 Gy / 54 Gy is safe and leads to significantly improved visual function. Interdisciplinary treatment decision and experience of the radiation oncology team play a major role.

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