Treatment of tumors involving the optic nerves and chiasm

An approach toward treatment of tumors involving the optic apparatus is presented. When tumors cause mass effect, microsurgical excision or debulking is generally recommended. Radiosurgery has been controversial yet advances in imaging and high speed computer planning allow treatment of lesions involving the optic apparatus with low morbidity. Microsurgical and radiosurgical approaches to tumors involving the globe, orbit, suprasellar region and third ventricle are discussed. Gamma Knife radiosurgery for choroidal melanomas spares orbital excenteration. We have used a marginal dose of 20–25 Gy for choroidal melanomas and generally limit the optic nerves and chiasm to less than 10 Gy in other cases. The effective dose for cavernous hemangiomas remains unclear, however we have had success with marginal doses in the range of 16–20Gy. Lower doses may prove successful yet better spare vision in cases where vision is useful. Our combined microsurgical and radiosurgical approach to tumors involving the apparatus has had an excellent rate of sparing vision, a low overall morbidity and excellent success.