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Optic nerve sheath meningiomas

  • Peerooz Saeed
    Affiliations
    Department of Ophthalmology, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada

    Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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  • Jack Rootman
    Correspondence
    Reprint requests to Jack Rootman, MD, FRCSC, Professor, Departments of Ophthalmology & Pathology, University of British Columbia, 2550 Willow Street, Vancouver, British Columbia, Canada V5Z 3N9.
    Affiliations
    Department of Ophthalmology, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada

    Department of Radiology, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Robert A Nugent
    Affiliations
    Department of Radiology, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Valerie A White
    Affiliations
    Department of Pathology, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Ian R Mackenzie
    Affiliations
    Department of Pathology, University of British Columbia and the Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Leo Koornneef
    Affiliations
    Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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      Abstract

      Purpose

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

      Design

      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.
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