Clinical Course of Optic Nerve Sheath Meningioma

Ji Min Lee; Si Yoon Park; Sang Yeul Lee; Jin Sook Yoon; Chang Yeom Kim

doi:10.3341/jkos.2016.57.9.1339

Journal List > J Korean Ophthalmol Soc > v.57(9) > 1010383

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Lee, Park, Lee, Yoon, and Kim: Clinical Course of Optic Nerve Sheath Meningioma

Original Article

J Korean Ophthalmol Soc 2016;57(9):1339-1347.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.9.1339

Clinical Course of Optic Nerve Sheath Meningioma

Ji Min Lee, MD¹, Si Yoon Park, MD¹, Sang Yeul Lee, MD, PhD², Jin Sook Yoon, MD, PhD¹, Chang Yeom Kim, MD, PhD¹

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Lee's Eye Clinic, Seoul, Korea

Address reprint requests to Chang Yeom Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: ecykim@yuhs.ac

Received 4 May 2016 Revised 11 July 2016 Accepted 19 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

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Keywords: Meningioma, Optic nerve sheath meningioma, Optic nerve tumor

References

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Figure 1.

Case 1.(A) This 45-year-old woman presented with decreased vision of the right eye. Her visual field examination shows inferior scotoma. (B) Her visual field showed increased visual field defect after 22 months.

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Figure 2.

Case 1. (A) Her coronal view of ganolinium-enhanced T1 magnetic resonance sequences show tubular-apical expansion optic nerve sheath meningioma (arrows) at first visit. (B, C) After 22 months, her tumor showed intracranial involvement (arrows).

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Figure 3.

Case 5. (A) This 40-year-old woman presented with decreased vision of the left eye. Her visual field examination shows inferior scotoma at left eye. (B) Her coronal view of ganolinium-enhanced T1 magnetic resonance sequences show tubular-form meningioma (arrow). The length of tumor was 25.12 mm in coronal view. (C) After Gamma-Knife surgery, her tumor sized decreased.

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Figure 4.

Case 4. (A) This 49-year-old woman presented with decreased vision and exophthalmos of her left eye. Her initial visual field examination showed temporal visual field defect of the left eye. (B) After three-dimensional conformal radiotherapy, her visual field remained unchanged. (C) Her gadolinium-enhanced T1 magnetic resonance sequences shows globular form optic nerve sheath meningioma, tumor size was 22.96 × 16.72 mm (arrow). (D) After three-dimensional conformal radiotherapy, tumor size slightly decreased (22.22 × 15.47 mm) on her orbital computed tomography using contrast and her exophthalmos decreased.

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Figure 5.

Case 9. (A) This 40-year-old woman presented with decreased vision of her left eye. Initial best corrected visual acuity was 0.7 and visual field examination showed no significant scotoma on her left eye. (B) She was diagnosed with optic nerve sheath meningioma of the left eye. The tumor size was 12.96 × 8.67 mm. (C) Her visual field examination was normal and unchanged.

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Table 1.

Demographics of patients

Pts	Gender	Age (yr)	Underlying disease	Laterality	Initial symptom	Difference of Exo (mm)	BCVA	Central VF defect	Limitation of EOM	Follow-up period (mo)
1	F	45	None	Right	Decreased vision	0.0	1.0	Yes	No	55
2	F	42	None	Left	Proptosis	5.0	0.7	Yes	Yes	62
3	F	55	None	Left	Decreased vision	3.0	0.7	Yes	No	116
4	F	49	None	Left	Decreased vision, proptosis	4.5	0.8	Yes	Yes	10
5	F	40	None	Left	Decreased vision	2.5	0.8	Yes	No	69
6	M	54	None	Right	Discovered accidentally	2.0	0.8	No	No	23
7	F	40	None	Left	Discovered accidentally	1.0	0.9	No	No	5
8	F	74	None	Left	Decreased vision	0.5	0.6	Yes	Yes	26
9	F	40	None	Left	Decreased vision	2.0	0.7	No	No	22
10	F	66	None	Right	Discovered accidentally	4.0	0.7	No	No	42
11	F	19	None	Right	Proptosis	5.0	0.4	Yes	No	Follow-up loss

Pts = patients; yr = year; Exo = exophthalmetric value; BCVA = best corrected visual acuity; VF = visual field (central visual field defect within 30 degrees); EOM = extraocular movement; mo = month; F = female; M = male.

Table 2.

Treatment results

Pts	Treatment modality	Best corrected visual acuity			Visual fields
Pts	Treatment modality	Initial	Pre-treatment	Post-treatment (mean period: 28 months)	Pre-treatment	Post-treatment
1	OP + GKS	1.0	0.7	NLP	Inferior scotoma	–
2	GKS	0.7	0.7	0.7	Total scotoma	Aggravated
3	RTx	0.7	0.2	0.2	Total scotoma	Improved
4	RTx	0.8	0.8	0.15	Temporal scotoma	No change
5	GKS	0.8	FC10	NLP	Inferonasal scotoma	–
6	observation	0.8	0.8	0.8	Peripheral Scotoma	No change
7	observation	0.9	0.9	0.8	Normal	Normal
8	observation	0.6	0.6	0.5	Inferior quadranopsia	No change
9	observation	0.7	0.7	0.8	Normal	Normal
10	observation	0.7	0.7	0.8	Normal	Normal
11	F/U loss	0.4	0.4	Unknown	Paracentral scotoma	–

Pts = patients; OP = operation; GKS = gamma-knife surgery; NLP = no light perception; RTx = radiotherapy; FC = finger count; F/U = follow-up.

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