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Solli E, Turbin RE. Primary and Secondary Optic Nerve Sheath Meningioma. J Neurol Surg B Skull Base 2021; 82:27-71. [PMID: 33777618 DOI: 10.1055/s-0041-1723801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective This study was aimed to review issues relating to the recognition, radiographic diagnosis, monitoring, and management of primary and secondary optic nerve sheath meningioma (ONSM). Design This study is a review of peer-reviewed literature combined with illustrative case studies. Participants and Methods A literature search was conducted via the PubMed database using pertinent search terms. Selected articles were limited to those written or translated into English. Additional works cited within articles were also included. Individual cases were drawn from the experience of a tertiary academic neuroophthalmic and orbital practice. Tables summarize radiotherapeutic and surgical studies, excluding single case reports and studies focusing on meningioma of intracranial origin. Main Outcome Measurements Review of reported surgical and radiotherapeutic series is the primary measurement. Results The natural history of optic nerve sheath meningiomas is primarily characterized by progressive ipsilateral vision loss. Diagnosis is typically based on radiographic imaging findings, with biopsy remaining indicated in some patients. Management strategies may include observation, radiation, and/or surgical intervention, or a combination of these approaches. The role of surgery, especially with respect to primary ONSM (pONSM), remains controversial. Advancement of radiotherapy techniques has shifted modern treatment paradigms in pONSM toward radiation as primary treatment, as surgical outcomes are inferior in major studies. Although radiation remains the treatment of choice in many cases, selected patients may benefit from surgery, especially in the setting of secondary ONSM (sONSM). Conclusion A wide variety of radiotherapeutic and surgical treatment modalities for ONSM exist. The specific indications for each management strategy continue to be redefined.
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Affiliation(s)
- Elena Solli
- Icahn School of Medicine at Mount Sinai, New York, New York, United States.,Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Roger E Turbin
- Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
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Eckert F, Clasen K, Kelbsch C, Tonagel F, Bender B, Tabatabai G, Zips D, Thorwarth D, Frey B, Becker G, Wilhelm H, Paulsen F. Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas. Radiat Oncol 2019; 14:240. [PMID: 31881902 PMCID: PMC6935075 DOI: 10.1186/s13014-019-1438-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022] Open
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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Affiliation(s)
- Franziska Eckert
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Kerstin Clasen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Carina Kelbsch
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Felix Tonagel
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Bettina Frey
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Gerd Becker
- RadioChirurgicum, CyberKnife Suedwest, Klinik am Eichert, Eichertstr. 3, 73035, Goeppingen, Germany
| | - Helmut Wilhelm
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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