Orbital optic nerve sheath meningioma

Surgical Neurology International

Background: Meningiomas correspond to one-third of all primary central nervous system tumors. Approximately 9% of them are spheno-orbital meningiomas (SOMs), presenting significant clinical symptoms as visual impairment and orbital esthetics. This article aims to evaluate exophthalmos’ improvement in a surgical series without orbital reconstruction. Methods: We consecutively included all patients diagnosed with SOM, admitted to a single institution for 10 years. Surgical resection was the standard of care, associated or not with adjuvant radiation therapy. The radiological investigation included preoperative and postoperative head CT or MRI. We quantified proptosis through imaging. Results: Forty patients composed this series, 87.5% were female. Proptosis was the most common presentation (90%), followed by decreased visual acuity (65%), motility deficit (20%), and headache (20%). Gross total resection was achieved in 65% of the procedures. In late outcomes, 78% of the patients maint...

European Journal of Ophthalmology, 2020

Purpose: To describe a standardized orbital resection technique and outcomes for spheno-orbital meningiomas with soft-tissue invasion of the orbit. Methods: A retrospective case review of patients with spheno-orbital meningioma that underwent resection utilizing the Alberta Standardized Orbital Technique (ASOT) between 2008 and 2017 was performed. Results: Twenty patients met the inclusion criteria. Fifteen females and five males, with an average age of 53.4 years (SD ± 13.1 years). Mean follow-up was 57.3 months (SD ± 29.5 months). Eight cases (40%) had attempted resection prior to referral. Based on pre-operative plan, patients were divided into two groups based on goal of resection. Of those with planned complete resection (Group I), 11/13 patients (84.6%) underwent complete excision, with no cases of orbital recurrence. Incomplete resection in two cases occurred because of unexpected involvement of critical intra-cranial structures. Thus, in total 9/20 patients (Group II and 2 f...

2014

SUMMARY Primary optic nerve sheath meningiomas (ONSM) are rare tumors of optic nerve which account for approximately 5-10% of orbital neoplasms. The classic triad of optic atrophy, progressive visual loss and presence of opticociliary shunt vessels is pathognomonic for the clinical presentation of ONSM however only a few percent of cases has this classic presentation. The most common presenting symptom in these patients is painless, progressive loss of visual acuity and dyschromatopsia. On clinical examination pathologic appearance of optic disc with varying degrees of optic atrophy is commonly observed. The goal of treatment for cases of ONSM is tumor control and improvement of vision. In cases with small and non-progressive tumor and high functional vision, conservative follow-up of the lesion is appropriate since surgical excision of ONSM is generally associated with high visual morbidities. Here we present a 67-year-old female patient with primary ONSM located on retrobulbar spa...

Journal of Neurosciences in Rural Practice, 2020

Background Spheno-orbital meningiomas (SOMs) constitute a rare cause for orbital proptosis and visual impairment. This study aims to share our outcome experience with regard to vision and exophthalmos following the surgical management of 17 patients with SOM. Methods Retrospective analysis of the case records of all surgically treated SOMs in the last 10 years. Exophthalmos index (EI) was calculated based on preoperative magnetic resonance imaging/computed tomography imaging. Vision was assessed using the Snellen’s chart and Goldman’s perimeter. Orbital volume was calculated using three-dimensional volume rendering assisted region-of-interest computation. Preoperative duration of symptoms and extent of surgery were the other predictors analyzed. Results Patients’ age ranged from 17 to 72 years (mean, 50.57 y; median, 50.0 years). Women represented 13 (76.4%) of the entire study group. Proptosis (14/17; 82.4%) and visual impairment (14/17; 82.3%) were the two most common presenting c...

American Journal of Ophthalmology, 2004

OBJECTIVE: Surgical strategies and results for 50 patients with meningiomas involving the optic nerves are discussed and evaluated. Factors affecting the degree of resection and patient outcomes are presented. We emphasize our surgical techniques for resection of these tumors and we discuss the advantages of different approaches, depending on the relationship of the tumor to the optic nerves. METHODS: Data for 50 patients with meningiomas involving the optic nerves who were surgically treated between 1991 and 2002 were reviewed, by using patient files, operative notes, and pre-and postoperative imaging and ophthalmological examination findings. RESULTS: Thirty-one female patients and 19 male patients, with a mean age of 53 years, were treated. Thirty-one patients (62%) underwent complete tumor removal (Simpson Grade 1 or 2), and 19 patients underwent subtotal removal (Grade 4). Factors affecting the grade of resection were tumor size (P ϭ 0.01), location (P ϭ 0.007), and internal carotid artery encasement (P ϭ 0.019). Patients who underwent Grade 1 or 2 resection exhibited a mean tumor size of 3.0 cm, and patients who underwent Grade 4 resection exhibited a mean tumor size of 4.1 cm. Only three patients had residual tumor on the optic nerve; all others had tumor in the cavernous sinus or at the orbital apex or exhibited vascular involvement. Visual outcomes were influenced predominantly by tumor size, preoperative visual function, and optic nerve encasement. CONCLUSION: Meningiomas that involve the optic nerves require special considerations and surgical techniques. Early decompression of the optic nerve within the bony canal allows identification and separation of the tumor from the nerve, permitting removal of the tumor from this area with minimal manipulation of the optic nerve.

British Journal of Ophthalmology, 2002

Zentralblatt für Neurochirurgie, 2008

This study proposes a topographical classification of spheno-orbital meningiomas. Its aim was to define whether the different intraorbital localizations require different surgical approaches and have different recurrence rates and outcomes. Sixty patients with spheno-orbital meningiomas operated upon between 1983 and 2003 were reviewed. Four types were identified according to the extent of intraorbital tumor invasion: I: lateral or superolateral (15 cases); II: medial and inferomedial (8 cases); III: orbital apex (25 cases); IV: diffuse (12 cases). Three surgical approaches were used: lateral orbitotomy (15 cases with lateral or superolateral tumors), supraorbital-pterional approach (42 cases, including all 8 inferomedial cases, all 25 orbital apex cases, and 9 of 12 diffuse tumors), and a fronto-temporal-orbitozygomatic approach (only 3 cases with diffuse meningiomas and large-scale tumor invasion in the infratemporal fossa and cavernous sinus). Tumor removal was complete (Simpson ...

Journal of Neurological Surgery Part B: Skull Base, 2020

Objective Primary goal in spheno-orbital meningioma (SOM) surgery still remains complete resection. Nevertheless, given their highly infiltrative nature, a growing body of literature suggests to shift toward function-sparing surgeries. We here present our experience in the management of SOMs through the endoscopic superior eyelid approach (SEA). Methods Surgical database from our multidisciplinary work group was retrospectively reviewed to identify patients treated for SOMs in the last 10 years by our senior authors, analyzing and correlating clinical, radiological, and outcome variables among the different approaches used. Results There were 35 patients (mean age of 57.3 ± 12.86 years), with a mean follow-up of 31.5 months (range: 6–84 months). The most common preoperative complaint was proptosis (62.9%) followed by diplopia and visual deficit. Greater and lesser sphenoid wings were the areas mainly involved by the pathology (91.4% and 88.6%, respectively), whereas orbital invasion...

Al-Azhar International Medical Journal (Print), 2022

Background: Spheno-orbital enplaque meningioma (SOEMs) are complex lesions that primarily originate in the sphenoid wing with extensive hyperostosis and may involve the orbit and cavernous sinus, making a gross total resection difficult and posing a high risk of postsurgical morbidity and recurrence. Aim of the work: To assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients. Patients and methods: a series of 13 consecutive patients with SOEM presented by proptosis and hyperostosis who underwent surgical excision by frontotemporal craniotomy, clinical, radiological, surgical technique and follow up was reviewed and analyzed. Results: In this series of 13 consecutive patients, 11 were women and 2 were men. The age range was from 35-63 years with a mean of 46.3 years. Tumors were located on the right side in 9 patients (69%) and the left side in 4 patients (31%). Cavernous sinus (CS) and superior orbital fissure (SOF) invasion in 4 cases (31%). Gross total excision grades I and II were obtained in 6 cases (46%), near total excision grades III in 3 cases (23%), and partial excision grade IV in 4 cases (31%). 11 cases (85%) show improvement of proptosis (7 patients, 54% have a complete resolution of proptosis and 4 cases, 31% have partial resolution of proptosis) and 2 cases show no improvement of proptosis after a long followup period. Conclusion: The decision for each case of Spheno-orbital enplaque meningioma should be individualized depending on the extension of the lesion to the surrounding structures. Extension to the CS and SOF should be considered the surgical limit for excision. Early presentation and surgery enable gross total resection, rapid improvement, and more stable follow-up.

Evidence Based Ophthalmology, 2002

Purpose: Comparison of treatment outcome in patients with primary optic nerve sheath meningioma (ONSM). Design: Retrospective, nonrandomized, comparative interventional case series. Participants: Sixty-four patients with at least 50 months of well-documented follow-up. Intervention: Observation, surgery only, radiotherapy only, or surgery and radiotherapy. Main Outcome Measures: Visual acuity expressed as ratio, radiographic progression, and treatment complications.

Operative Neurosurgery, 2017

BACKGROUND Feasibility and safety of spheno-orbital meningioma resection by means of endoscopic-assisted transorbital route. OBJECTIVE To evaluate the feasibility and outcomes of the transorbital endoscopic management of selected spheno-orbital meningiomas. As secondary aims, symptom improvement and tumor volume removed were evaluated. METHODS Retrospective chart evaluation of patients with spheno-orbital meningiomas treated by means of endoscopic transorbital superior eyelid approach in 3 referral centers over the last 4 yr. RESULTS Fourteen cases were included in this study. In 4 patients, the transorbital endoscopic approach was combined with an endonasal route. Mean age was 51 and male-to-female ratio was 1:6. In 8 patients (57.1%), an intraorbital involvement was observed, 3 of them (21.4%) showed significant intraconal disease. No patient presented significant cavernous sinus infiltration. Main presenting symptoms were proptosis, diplopia, and visual impairment in 14, 6, and 6...

Japanese Journal of Ophthalmology, 2005

Canadian Journal of Neurological Sciences, 2003

Meningiomas of the anterior cranial fossa frequently present with impaired visual function. Recognition of this entity in the differential diagnosis of painless, progressive, and asymmetric optic neuropathy is important since reversal of visual loss is possible given timely surgical excision of the tumour. A 76-year-old man presented with no perception of light in his right eye and a reduced visual acuity of 20/60 in his left eye with a markedly constricted visual field. His visual deterioration had progressed over the previous three months and was not associated with headache. Ophthalmoscopy showed normal optic discs. MRI scanning showed a large frontal basal meningioma, which was subsequently resected. The patient noticed an immediate improvement in his vision in his right eye. Visual acuity in his right eye improved to 20/50 at six weeks postoperatively and to 20/25 at five months, with corresponding improvement of the visual field. Complete monocular blindness due to tumour comp...

Journal of Medical - Clinical Research & Reviews, 2018

Statement of the Problem: Meningiomas are benign extra-axial tumors, originating from the meningeal arachnoidal cells, making up 20% of the intracranial primary tumors. Surgical management of meningiomas is one of the most challenging procedures posing a high risk of affecting the critical neurovascular centers of the brain. Our study attempts to identify the way paraclinical brain investigations coupled with a well-established surgical procedure lead to an efficient and strategic treatment of meningioma, starting with a case of a 50-year-old woman. Case presentation: The clinical background of the patient included frontal headaches, rare epileptic crises, and sudden dizziness. In addition to the MRI which presented a homogenous irregular expanding tumor process in the frontal-orbital left space, several other investigations such as Digital Angiography and Computed Tomography were performed. The treatment was mainly focused on the neurosurgical intervention, having several purposes: rejecting the meningioma, establishing the anatomopathological diagnosis and developing the therapeutic plan. The surgical approach involved a step-by-step incision, tumor fragmentation and Simpson 2 excision. The final result was favourable-the patient regained her balance. Conclusion & Significance: Getting a better understanding of the neurosurgical steps of treating meningiomas will lead to finding strategies that will improve the patient's treatment and his quality of life.

Journal of Radiation Research, 2011

Optic nerve sheath meningioma/Stereotactic radiotherapy/Fractionation. Optic nerve sheath meningioma (ONSM) is a rare orbital tumor that generally induces a slow progressive visual loss in affected patients. Radiotherapy (RT) has currently become the first choice to treat ONSM. In this study our experience in ONSM treatment with fractionated stereotactic radiotherapy (FSRT) is reported. Five patients with diagnosis of orbital ONSM were treated between April 2007 and December 2009 at the Radiation Oncology department of our institution. All patients underwent history and physical, and ophthalmic examinations. Orbital MRI was performed before and 6 weeks after treatment; thereafter every 6 months for the first 2 years. By previous stereotactic localization of the target, RT was delivered with 28 daily fraction of 1.8 Gy by multiple non coplanar arcs dynamically conformed by a micro multileaf-collimator. At diagnosis, in all 5 patients, visual acuity limitations of different degrees were found, while exophthalmos was present in 2, diplopy in 2, orbital pain in 1, and proptosis in 1. In all patients pre-treatment MRI showed an orbital mass involving the optic nerve. After radiotherapy, previous symptoms improved in all patients. However, after RT the MRI consistently showed a stationary status compared to the MRI before RT. At a median follow up of 26 months (range 9-37) all patients had a subjective and/or objective better visual performance than before RT without any evidence of disease progression. No late side effects were recorded. Accordingly to the current literature, our experience confirms the efficacy and the safety of FSRT in patients with orbital ONSM.