The role of surgery in meningiomas involving the optic nerve sheath.
OBJECTIVE
Clinical presentation, radiological appearance and treatment options of patients with optic nerve sheath meningiomas (ONSM) vary. To provide a baseline for treatment of this tumour entity a series of 24 patients with ONSM is presented.


METHODS
Clinical charts of the patients including surgical and histological records, imaging studies as well as meticulously focusing questionnaires of clinical outcome were reviewed.


RESULTS
Twenty four patients with ONSM were treated at the Neurosurgical Department from 1981 to 2002. Mean age at diagnosis was 44 years (14-69) with a female:male ratio of 7:1. The preoperative duration of symptoms was negatively correlated with the preoperative visual acuity. The microsurgical approach consisted of pterional craniotomy, intra-/extradural subtotal excision of the meningioma and bony decompression of the optic canal. Surgical results showed low surgical morbidity and preserved or even improved vision in 8/16 patients (50%) all of whom had rapid visual decline preoperatively. In the long-term, visual loss occur again occurred due to recurrence in about 20% of cases.


CONCLUSIONS
Microneurosurgery for treatment of ONSMs is still reserved for cases with intracranial extension, disfiguring proptosis and patients with rapid visual deterioration. Radiotherapy should be considered as treatment option in all other cases as it prolongs the time for functional vision in the affected eye with low morbidity.
Roser
Florian
F
Department of Neurosurgery, Klinikum Hannover Nordstadt, Germany; Department of Neurosurgery, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany. f.roser@gmx.de
Nakamura
Makoto
M
Martini-Thomas
Rosa
R
Samii
Madjid
M
Tatagiba
Marcos
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000453:epidemiology; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D008579:Meningioma / Q000473:pathology* / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D019635:Neurosurgical Procedures / Q000379:methods*; D009898:Optic Disk / Q000473:pathology; D009900:Optic Nerve / Q000473:pathology* / Q000601:surgery*; D010146:Pain / Q000453:epidemiology; D011183:Postoperative Complications; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology; D014792:Visual Acuity