Cystic optic nerve sheath meningioma.

A 58-year-old woman with a 35-year history of left proptosis underwent neuroimaging that revealed a large cystic lesion. Surgery revealed an optic nerve sheath meningioma associated with cyst formation. The cyst was part of the tumor, a phenomenon that is well described in intracranial meningiomas but not in optic nerve sheath meningiomas.     

A primary optic nerve sheath chordoid meningioma

Primary optic nerve sheath meningiomas (ONM) are rare. Most of these are World Health Organization Grade I meningiomas. Because of the intimate relationship to the optic nerve sheath from which they arise, radical excision is often not feasible. The chordoid variant of meningioma is an infrequent tumor and extremely uncommon among primary ONMs. We report a 36-year-old woman with painless proptosis and normal visual acuity who presented to us with an exophytic intraconal mass, which was excised. Histology revealed a chordoid meningioma. We could find only two previous reports, which are discussed.     

Sphenoid and optic nerve sheath meningioma revealed by recurrent brain infarctions

Meningioma, though benign, may invade adjacent structures such as bone, soft tissues, dural sinuses and arteries. However brain infarctions secondary to meningioma involving the cavernous sinus and encasing and narrowing the intracranial carotid artery are rare. We report the case of a young man with recurrent left carotid artery infarctions due to a left sphenoid meningioma infiltrating the posterior optic nerve sheath through the optic canal and circumscribing the intracranial carotid artery. The patient had a gradually progressive occlusion of the middle cerebral artery, the distal internal carotid artery and finally the anterior cerebral artery ipsilateral to the sphenoid meningioma.     

New concepts in the diagnosis and management of optic nerve sheath meningioma.

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.     

Diagnosis and management of optic nerve sheath meningiomas

Optic nerve sheath meningiomas account for a third of all intrinsic tumours of the optic nerve. Despite their classification as histologically benign tumours they cause progressive visual loss that often leads to blindness if left untreated. Recent therapeutic advances have increased the treatment options available to clinicians but patient management remains controversial. We systematically review the progress made in the diagnosis and management of optic nerve sheath meningiomas, clarify current best practice, and suggest future avenues for research.     

Clinical without histopathological manifestations of inflammation in a patient with primary intraorbital optic nerve sheath meningioma.

A 28-year-old man with a biopsy-proven benign intraorbital optic nerve sheath meningioma developed recurrent clinical manifestations of ipsilateral retrobulbar inflammation 9 years after undergoing postoperative radiation therapy. Debulking of the tumor 11 years after the original surgery again revealed no pathologic signs of inflammation. Whether growth of tumor, surgery, radiation, or edema triggered the inflammatory manifestations is unclear. Our case affirms that primary optic nerve meningiomas may rarely cause episodic manifestations resembling those of idiopathic orbital inflammation that resolve with corticosteroid treatment.     

视神经鞘脑膜瘤(附5例报道)

目的 探讨显微神经外科技术在治疗视神经鞘脑膜瘤中的作用。方法 5例视神经鞘脑膜瘤均采用显做外科切除，1例采用额颞入路，2例为改良翼点入路，2例经眶额-翼点入路。术中力求解剖保留视神经。对比手术前后视力改变，以评价手术效果。结果 肿瘤全切3例，视神经解剖保留4例。术后视力情况：1例较术前进步，1例无变化，3例完全失明。结论 显做神经外科技术多可以解剖保留视神经，但很少能保留视力。     

伽玛刀治疗原发性视神经鞘脑膜瘤中长期疗效观察及近期文献回顾、

目的评估伽玛刀治疗原发性视神经鞘脑膜瘤（PONSM）的中长期疗效。方法回顾性分析26例经伽玛刀治疗的PONSM病人的临床资料。疗效评估主要依据肿瘤体积控制率及视力控制率。利用Kaplan—Meier生存曲线法分析病人肿瘤体积及视力稳定率。结果随访12—66个月,肿瘤体积控制率为96．2％,视力控制率为65．4％。肿瘤体积稳定时间39．4～59．1个月,平均49．4个月;视力稳定时间29．6—46．2个月,平均37．9个月。Kaplan—Meier曲线显示：肿瘤体积约在术后30个月趋于稳定,此时肿瘤体积稳定率约为70％：视力约在术后24个月趋于稳定,此时视力稳定率约为67％。结论伽玛刀治疗PONSM的中长期疗效较好,不仅可控制肿瘤生长,也可在一定程度上维持病人的视力,但需经过一定时间后肿瘤体积和视力才可达到稳定。     

Fractionated radiotherapy for optic nerve sheath meningiomas

Optic nerve sheath meningiomas (ONSM) are rare tumors of the meninges that surround the optic nerve as it enters the orbit. If left untreated, these benign tumors lead to progressive compression of the optic nerve and vascular compromise resulting in visual loss. Surgical resection of ONSM is associated with a high morbidity due to injury to the vascular supply of the optic nerve, with up to 94% of patients reporting worsened vision post-operatively. Fractionated radiotherapy is a non-invasive alternative to surgery for the treatment of ONSM that has demonstrated improved outcomes. The reported long-term tumor control rates approach 100%, with greater than 80% vision preservation or improvement after treatment. Recently, improved technology for delivery of radiotherapy, including stereotactic and three-dimensional conformal radiotherapy has emerged. The literature suggests that the modality of radiotherapy does not affect the outcomes as long as conformal targeting with a total dose of 50 Gy to 54 Gy and a fractional dose of less than 2.0 Gy is used. Radiosurgery is not generally used for ONSM due to the high toxicity to the optic nerve when high-dose single fraction radiation is given. Therefore, conformal fractionated radiotherapy appears to be the most effective treatment for ONSM, and should be used as a primary therapy unless there is a specific indication for surgical intervention.     

Terson syndrome with bilateral optic nerve sheath hemorrhage.

A 53-year-old man presented with an acute headache and mental status changes due to rupture of an anterior choroidal artery aneurysm. A preoperative CT scan demonstrated subarachnoid hemorrhage, bilateral optic nerve sheath hemorrhage, and bilateral intraocular hemorrhage. Ophthalmoscopy and B-scan ocular ultrasound disclosed vitreous hemorrhages, features consistent with Terson syndrome. This is the first CT report of Terson syndrome showing bilateral optic nerve sheath hemorrhage.     

Optic nerve sheath meningioma. Experience in Lyon with twenty patients

Meningioma is an unfrequent optic nerve tumor. Clinical symptoms are not specific, and pathology exam not easily accessible. The diagnosis is usually based on imaging findings. We report our experience, based on twenty patients. Most of them were middle-aged women (mean age=47 years old). The optic nerve meningioma (ONM) was often revealed by visual dysfunction. Ophthalmological evaluation was altered in most patients (visual acuity, visual fields, fundi). The gold-standard exam was MRI of the optic nerve, with and without gadolinium, and with fat-sat sequences. Thirty percent of the lesions remain stable without treatment. Functional prognosis has been improved only by conformal fractionated radiotherapy, but indications and modalities remain to be specified.     

Pre-chiasmatic transection of the optic nerve can save contralateral vision in patients with optic nerve sheath meningioms

Objectives

With respect to its characteristic pattern of growth from the orbit into the intracranial space toward the chiasm, patients with optic nerve sheath meningiomas (ONSM) are threatened to loose function of both optic nerves. Fortunately, in less than 5% both optic nerves are involved initially. Hence, prevention of vision of the contralateral eye is the foremost aim of any therapy. Performing pre-chiasmatic transection might offer a further treatment option to avoid further tumor growth toward the chiasm.

Patients and methods

In this retrospective study 12 patients with ONSM and blindness of the affected eye were included. The surgical approach was performed either from pterional intradural or as a combined approach from pterional extra- and intradural.

Results

Without any exceptions, vision of the contralateral eye could be preserved and did not show any deterioration after surgery or during the follow-up time of 50.6 months. Furthermore in 58.3% of patients gross total tumor resection could be achieved. During follow up observation in 67% of patients no further tumor progress or recurrences could be observed. 4 patients, however, showed delayed tumor progress or recurrences that were treated by radiotherapy.

Conclusion

Pre-chiasmatic transection of the optic nerve might offer a surgical treatment option to control tumor growth and to preserve vision of the contralateral eye.     

Evaluating the optic nerve stiffness and optic nerve sheath diameter in idiopathic intracranial hypertension patients after the resolution of papilledema

Neurological Sciences - The objective of this study was to investigate the optic nerve’s elastic properties and optic nerve sheath diameter (ONSD) using shear-wave elastography (SWE) in...