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Munk Bang M, Schou Andersen MC, Rom Poulsen F, Bonde Pedersen C, Darling P, Jakobsen J, Bechtold D, Dehghani Molander L, Hedegaard Dahlrot R, Nguyen N, Halle B. Treatment of Meningiomas Involving the Optic Canal with Endoscopic Transnasal Decompression of the Optic Nerve. World Neurosurg 2024; 187:e629-e637. [PMID: 38692572 DOI: 10.1016/j.wneu.2024.04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Management of patients with optic nerve sheath meningiomas (ONSMs) is controversial and the treatment strategy in this patient group is still up for discussion. Transnasal endoscopic orbital and optic nerve decompression aims to reduce the pressure in the orbit and on the optic nerve and thereby prevent vision loss. This article presents material from 7 cases of transnasal endoscopic orbital decompression. METHODS The study design is a retrospective cohort study. The aim was to include all patients with a meningioma residing along the nerve sheath and who were operated using endoscopic transnasal decompression of the orbit and if needed the optic canal at Odense University Hospital. Data from the medical records were collected and pre- and postoperative eye examinations were compared. In addition, it was recorded whether there were complications to the procedure and whether additional treatments were given. RESULTS In total, 4 women and 3 men were included in the study. Four out of 7 patients experienced improvement in vision after the operation. One patient experienced unchanged vision and 2 patients experienced deterioration of vision after surgery. CONCLUSIONS The current report of 7 patients with ONSM shows promising results for this surgical procedure as 4 out of 7 patients experienced improvement in their vision at follow-up examinations. The 2 patients who experienced deterioration of vision already had severely reduced vision preoperatively, which indicates that surgery should be considered before the vision becomes significantly reduced.
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Affiliation(s)
- Martin Munk Bang
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.
| | | | | | | | - Peter Darling
- Department of ORL, Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - John Jakobsen
- Department of ORL, Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Dorte Bechtold
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | | | | | - Nina Nguyen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
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Sergeeva NA, Serova NK, Galkin MV, Golanov AV, Zagirov RI. [Results of radiation therapy for optic nerve sheath meningioma]. Vestn Oftalmol 2022; 138:5-13. [PMID: 36288412 DOI: 10.17116/oftalma20221380515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
UNLABELLED Optic nerve sheath meningioma (ONSM) is a slow-growing benign tumor that tends to extend intracranially. The tumor is characterized by vision disturbance, optic nerve atrophy and edema. At present, radiotherapy is recommended as the treatment of choice for ONSM. PURPOSE To assess the neuro-ophthalmic symptomatology of ONSM and how it changes in response to radiotherapy. MATERIAL AND METHODS In the period from 2004 to 2018, 112 patients with ONSM aged 17 to 76 years underwent stereotactic radiotherapy. In 91 patients, visual functions varied from light perception to 1.0; in 21 patients the affected eye was blind. The prospective follow-up of 103 patients lasted 6 months to 10 years (mean follow-up duration was 57 months). Studied patients underwent either conventional fractionated radiotherapy with Novalis (n=88) or hypofractionation radiotherapy with CyberKnife (n=24). RESULTS According to ophthalmological examination, in 60.5% of cases an improvement of visual functions was observed, 39.5% of patients had visual functions remain stable at the initial level. No vision impairment during irradiation was detected. Vision deterioration in the long-term follow-up was observed in 2 patients: extended tumor growth in one case and radio-induced retinopathy in the other. CONCLUSION The study showed that this method of treatment for ONSM is effective and safe, allowing preservation of visual functions and in some cases - its improvement, while tumor growth remains under control.
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Affiliation(s)
- N A Sergeeva
- N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia
| | - N K Serova
- N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia
| | - M V Galkin
- N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia
| | - A V Golanov
- N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia
| | - R I Zagirov
- N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia
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de Melo LP, Arruda Viani G, de Paula JS. Radiotherapy for the treatment of optic nerve sheath meningioma: A systematic review and meta-analysis. Radiother Oncol 2021; 165:135-141. [PMID: 34688809 DOI: 10.1016/j.radonc.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The management of Optic Nerve Sheath Meningiomas (ONSM) has suffered a significant shift due to new radiation techniques. However, there is no conclusive information on which approach presents better results in the literature. This meta-analysis aims to evaluate the outcomes of different radiotherapy (RT) modalities in the management of ONSM. METHODS A systematic review based on an electronic search was performed in MEDLINE, EMBASE, Cochrane, and Lilacs databases. Eligible studies included patients with ONSM treated with RT. Two reviewers independently assessed the eligibility of potential studies, extracted data, and performed the meta-analysis. Outcomes of interest were tumor control, visual acuity (VA), visual field, and complications. RESULTS Thirty-nine non-comparative studies involving 736 eyes with ONSM treated with RT were included. Six different techniques were studied: 2-dimensional RT (2DRT), 3D-conformal RT (3CRT), Stereotactic Fractionation RT (SFRT), stereotactic radiosurgery (SRS), intensity-modulated RT (IMRT), and proton beam therapy (PBT). With a mean follow-up period of 46 months, tumor control was 97,4% (95% CI: 98-100%). No difference was observed regarding the rate of final VA post-treatment among the modalities. The 3CRT showed substantially higher rates of complication than other techniques. CONCLUSIONS RT produces remarkable tumor control. New radiation modalities such as SFRT, IMRT, SRS, and PBT resulted in better therapeutic results with fewer complications than 2DRT and 3CRT. Thus, they should be the preferential choices for treating ONSM regardless of initial clinical presentation.
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Affiliation(s)
- Laísa Pereira de Melo
- Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Arruda Viani
- Department of Image Sciences and Medical Physics, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.
| | - Jayter Silva de Paula
- Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
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68Ga-DOTATOC-PET/MRI-A Secure One-Stop Shop Imaging Tool for Robotic Radiosurgery Treatment Planning in Patients with Optic Nerve Sheath Meningioma. Cancers (Basel) 2021; 13:cancers13133305. [PMID: 34282752 PMCID: PMC8267930 DOI: 10.3390/cancers13133305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Optic nerve sheath meningiomas (ONSM) are rare but can lead to irreversible blindness. Hybrid imaging may enhance tumor delineation and diagnostic accuracy via receptor binding. However, relevant clinical data for ONSM are lacking. We evaluated the feasibility of receptor-based hybrid imaging prior to robotic radiosurgery (RRS). We retrospectively analyzed all of our institution's patients with suspected ONSM who underwent combined positron emission tomography and magnetic resonance imaging (PET/MRI) with gallium-68-labeled (DOTA0-Phe1-Tyr3) octreotide (Ga68-DOTATOC) before RRS between 2018 and 2019. Eight patients with ten suspected ONSM (female = 7; median age, 51.2 years; IQR, 43.0-66.0) were included. Nine out of ten ONSM were deemed PET-positive with a median standard uptake value (SUV) max of 5.6 (IQR, 2.6-7.8). For all nine ONSM that presented 68Ga-DOTATOC uptake, hybrid PET/MRI was used for target volume contouring prior to RSS. At a median follow-up of 11.7 months (IQR, 9.4-16.4), tumor control was achieved in all patients. Radiosurgery resulted in the improvement of visual acuity in two of eight patients, whereas six showed stable vision. Ga68-DOTATOC-PET/MRI can be used for target volume contouring prior to RRS for ONSM as it enables safe treatment planning and improves diagnostic accuracy.
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Parker RT, Ovens CA, Fraser CL, Samarawickrama C. Optic nerve sheath meningiomas: prevalence, impact, and management strategies. Eye Brain 2018; 10:85-99. [PMID: 30498385 PMCID: PMC6207092 DOI: 10.2147/eb.s144345] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate is practically zero, these tumors can blind or disfigure patients. Given that the clinical course can be variable, and treatment has the capacity to cause morbidity itself, the management of these patients can be difficult. We review the literature to discuss the prevalence of optic nerve sheath meningiomas, the association with neurofibromatosis type 2, natural history, and management options and strategies.
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Affiliation(s)
- Richard T Parker
- Sydney Medical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia,
| | - Christopher A Ovens
- Sydney Medical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia,
| | - Clare L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Chameen Samarawickrama
- Sydney Medical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia, .,Department of Ophthalmology, Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,
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Optic Nerve Sheath Meningiomas — Non-surgical Treatment. Clin Oncol (R Coll Radiol) 2009; 21:8-13. [DOI: 10.1016/j.clon.2008.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 10/14/2008] [Accepted: 10/23/2008] [Indexed: 11/17/2022]
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Abstract
Optic nerve sheath meningiomas are by far the most common tumors of the optic nerve sheath. The diagnosis can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. Observation may be appropriate in patients with mild or no visual deficit or in whom visual loss is not progressing, whereas stereotactic fractionated radiation therapy has been demonstrated to improve or stabilize vision in progressive or advanced cases. Attempts at surgical excision, and even biopsy, of optic nerve sheath meningiomas are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumor with focal involvement of the dural sheath.
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Affiliation(s)
- Neil R Miller
- Wilmer Eye Institute, the Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Berman D, Miller NR. New Concepts in the Management of Optic Nerve Sheath Meningiomas. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n3p168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: Primary optic nerve sheath meningiomas (ONSMs) are the most common primary tumours of the optic nerve sheath. The diagnosis and management of ONSMs have changed dramatically in the last decade. In this review article, we discuss the latest information regarding these issues.
Materials and Methods: References for this manuscript were obtained by searching the database PubMed using the phrase “optic nerve sheath meningioma”. Approximately 150 articles were identified and reviewed. These articles served as reference sources for other articles, books and chapters on the subject. The results were combined with our personal experience, which includes over 100 cases of ONSMs that have been observed or treated with one or more of the modalities described below.
Results: The diagnosis of ONSM can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. Management depends on several factors. Observation may be appropriate in patients with mild or no visual deficit or in whom visual loss is not progressing, whereas stereotactic fractionated radiation therapy has been documented to improve or stabilise vision in progressive or advanced cases. Attempts at excision of ONSMs are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumour with focal involvement of the dural sheath. Rare patients with acute visual deterioration may benefit from optic nerve sheath fenestration.
Conclusion: The majority of ONSMs can be suspected on clinical grounds and diagnosed with readily available non-invasive neuroimaging. Stereotactic fractionated radiotherapy is currently the treatment of choice for ONSMs that require therapy.
Key words: Meningioma, Optic nerve, Optic nerve sheath, Radiotherapy
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Affiliation(s)
- Dalia Berman
- Johns Hopkins Hospital, Baltimore, Maryland, USA
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Abstract
Optic nerve sheath meningioma is an uncommon tumor of middle age. Patients most often present with progressive visual loss, mild proptosis, and, occasionally, ocular motility defect. With modern neuroimaging, these tumors are relatively easy to diagnose. However, the computed tomography scan or magnetic resonance imaging scan obtained must be a high-resolution study focused on the optic nerve. Clinical observation may be appropriate for patients with relatively preserved vision. However, when vision deteriorates, fractionated stereotactic radiotherapy is indicated and can often restore or preserve visual function.
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Affiliation(s)
- Mark L Moster
- Albert Einstein Medical Center, 5401 Old York Road, Philadelphia, PA 19141, USA.
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