Primary optic nerve sheath meningiomas

Report of nine cases

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✓ Between 1979 and 1987 the authors treated nine cases of primary optic nerve sheath meningioma. The definitive treatment for these lesions is surgical resection, although no single best plan for optimal management has been determined. The data indicate that only small anterior tumors may be removed with preservation of useful vision. With posterior circumferential tumors, there have been no cases of tumor removal with preservation of vision. A management strategy directed toward preservation of vision is discussed.

Article Information

Address reprint requests to: W. Craig Clark, M.D., Ph.D., University of Tennessee, Department of Neurosurgery, 956 Court Avenue, Coleman Building, Room A-202, Memphis, Tennessee 38163.

© AANS, except where prohibited by US copyright law.

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Figures

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    Diagrams showing variations in the growth pattern of optic nerve sheath meningiomas. a: Inset showing how fraying of dural sheaths at the posterior aspect of the globe allows the tumor to extend into the orbit early in the course, sparing the optic nerve. b: Inset demonstrating how posterior tumors are constrained within the dural sheath, resulting in circumferential compression and invasion of the optic nerve.

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    Photograph showing the retinociliary shunt vessels (arrowhead) that are often seen with optic nerve sheath meningiomas.

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    Diagram showing chronic compression of the optic nerve and its blood supply. This leads to chronic optic disc swelling and the formation of retinociliary shunt vessels that connect the central retinal vein with peripapillary choroidal veins.

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    High-resolution computerized tomography appearance of primary optic nerve sheath meningiomas. Left: Axial scan showing the enhanced margin of tumor surrounding the nerve posteriorly in the orbit, producing a tram track appearance. Right: Coronal views demonstrating the tumor surrounding the nerve (arrowheads), resulting in a doughnut or target configuration. Compare this appearance with that of the normal left side.

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