Diagnosis Of Optic Nerve Sheath Meningioma Research Articles

Clinical Course of Optic Nerve Sheath Meningioma

Purpose: To evaluate the clinical course of optic nerve sheath meningioma (ONSM) in Korean patients. Methods: A retrospective study of 11 eyes of 11 patients with a diagnosis of ONSM between 2002 and 2015 at Severance Hospital. Results: The mean age at symptom onset was 47.6 years. Ten females and 1 male participated in the study and all tumors were unilateral. Patients typically presented with visual loss and proptosis. Three patients complained of limited extraocular movements and seven patients exhibited visual field defects. Three patients who had a greater growth rate with intracranial involvement and two patients who had decreased vision received treatments. Five patients maintained good vision and visual field during the follow-up period. However, one patient who underwent surgical treatment presented significant visual loss and deterioration of visual field defect. One out of two patients who received three-dimensional conformal radiotherapy (3D-CRT) experienced improvement in visual field, and the other showed no change in visual field defect but remained stable with decreased tumor size. One out of two patients who underwent gamma-knife surgery showed aggravated visual field defect and the other presented with visual loss. Conclusions: ONSM is typically a slow-growing tumor. Deterioration of visual loss and visual field defect can occur after treatment of ONSM. Therefore, management should be considered carefully and should be limited to cases in which progression of the disease is advanced or tumor growth is fast. 3D-CRT can be considered in patients in need of treatment. J Korean Ophthalmol Soc 2016;57(9):1339-1347

Somatostatin Receptor Scintigraphy for Optic Nerve Sheath Meningiomas

To investigate the value of somatostatin receptor scintigraphy (SSRS) in the diagnosis of optic nerve sheath meningiomas (ONSMs). Prospective, comparative case series. SSRS was used to investigate 68 orbits in 61 patients diagnosed with an orbital tumor. Patients were injected intravenously with 200 MBq of indium-111 ((111)In)-octreotide. SSRS with single photon emission computed tomography (SPECT) was performed 24 hours after injection. The (111)In-octreotide uptake in orbital lesions was determined by semiquantitative uptake-ratio analysis (lesion/brain) on attenuation-corrected transverse SPECT slices. All orbital meningiomas, including 14 ONSMs and 12 spheno-orbital meningiomas, showed high median (111)In-octreotide uptake ratios of 7.2 (range, 4.6-15.4) and 16.3 (range, 4.6-15.4), respectively. In 7 patients with a diagnosis of ONSM, the SSRS uptake ratio was significantly decreased 2.7 (1-6.8) after treatment with 54 Gy of radiotherapy. Median uptake ratios of other tumors were vascular anomalies/vascular tumors, 1.2 (range, 0.5-3.3); non-Hodgkin lymphomas, 2.9 (range, 0.9-4.2); optic nerve gliomas, 1.5 (range, 0.2-3.3); and idiopathic orbital inflammation, 1.6 (range, 1.4-1.9). By using a threshold uptake ratio of 5.9, the sensitivity of SSRS with (111)In-octreotide for ONSM was 100%, with a specificity of 97.2%. SSRS is a useful additional tool in diagnosing ONSM and has 100% sensitivity and 97% specificity at a threshold uptake ratio of 5.9.

New Concepts in the Management of Optic Nerve Sheath Meningiomas

Primary optic nerve sheath meningiomas (ONSMs) are the most common primary tumours of the optic nerve sheath. The diagnosis and management of ONSMs have changed dramatically in the last decade. In this review article, we discuss the latest information regarding these issues. References for this manuscript were obtained by searching the database PubMed using the phrase "optic nerve sheath meningioma". Approximately 150 articles were identified and reviewed. These articles served as reference sources for other articles, books and chapters on the subject. The results were combined with our personal experience, which includes over 100 cases of ONSMs that have been observed or treated with one or more of the modalities described below. The diagnosis of ONSM can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. Management depends on several factors. 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 documented to improve or stabilise vision in progressive or advanced cases. Attempts at excision of ONSMs are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumour with focal involvement of the dural sheath. Rare patients with acute visual deterioration may benefit from optic nerve sheath fenestration. The majority of ONSMs can be suspected on clinical grounds and diagnosed with readily available non-invasive neuroimaging. Stereotactic fractionated radiotherapy is currently the treatment of choice for ONSMs that require therapy.

Optic Nerve Sheath Meningiomas in Patients With Neurofibromatosis Type 2

To determine the prevalence of optic nerve sheath meningiomas (ONSMs) in patients with neurofibromatosis type 2 (NF2). An observational retrospective case series of 30 consecutive patients with NF2 referred to an academic ophthalmology unit from November 1, 1991, through August 31, 2003. Twenty-six patients were followed up for a mean of 93 months (range, 3-150 months). One individual was lost to follow-up, and 3 had been referred recently. Diagnosis of ONSM was made based on typical neuroradiologic and clinical features in 7 patients and on histologic criteria in 1. Eight of 30 patients harbored unilateral (n = 6) or bilateral (n = 2) ONSMs. Six ONSMs were diagnosed at initial examination, and 4 during follow-up. There is a strong association between ONSMs and NF2 that parallels the well-known association of optic nerve gliomas with NF1. Physicians should be aware of the possibility that patients with ONSMs may also have NF2.