Optic nerve sheath meningiomas.
OBJECTIVE
To study the natural history and growth of optic nerve sheath meningiomas and evaluate their management outcome.


METHODS
Clinicopathologic retrospective noncomparative case series.


METHODS
A retrospective study of 88 patients who were treated between 1976 and 1999 at the University of British Columbia and the University of Amsterdam. Clinical reports, imaging studies, and histopathologic findings were reviewed.


RESULTS
The mean age at onset of symptoms was 40.3 years, and most were seen in middle-aged females. Patients typically presented with visual loss, frequently associated with optic atrophy or papilledema and occasionally optociliary shunt vessels. On imaging, the optic nerve demonstrated segmental or diffuse thickening of the sheath or globular growth. Calcification was seen in 31% of cases and was associated with slower tumor growth. Tumors with posterior components in the orbit had more frequent intracranial involvement. Intracranial extension was more frequent and had a greater growth rate in younger patients. Irregular margins in the orbit implied local invasion. A presenting visual acuity better than 20/50 correlated with longer preservation of vision. Patients who underwent radiotherapy showed improvement in their visual acuity, and tumor growth was halted. Optic sheath decompression did not preserve vision. En bloc tumor excision was associated with no detectable recurrence in contrast to debulked tumors that recurred.


CONCLUSIONS
Meningiomas show characteristic indolent growth. Management therefore should be conservative in most cases. Radiotherapy is indicated in patients with progressive visual deterioration. Surgery, when indicated, should be an en bloc excision.
Saeed
Peerooz
P
Department of Ophthalmology, University of British Columbia and the Vancouver General Hospital, 2550 Willow Street, Vancouver, British Columbia, Canada V5Z 3N9.
Rootman
Jack
J
Nugent
Robert A
RA
White
Valerie A
VA
Mackenzie
Ian R
IR
Koornneef
Leo
L
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D008579:Meningioma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D019574:Optic Nerve Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed