Prognostic factors in the surgical treatment of intracanalicular primary optic nerve sheath meningiomas

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OBJECTIVE

Although meningiomas frequently involve the optic nerve, primary optic nerve sheath meningiomas (ONSMs) are rare, accounting for only 1% of all meningiomas. Given the high risk of vision loss with these tumors, surgical intervention is seldom considered, and radiation or observation is commonly applied. Here, the authors describe the visual outcomes for a series of patients who were treated with surgery aiming at maximal tumor resection and highlight their prognostic factors.

METHODS

The authors retrospectively analyzed the data for 8 patients with intracanalicular ONSMs who had been surgically treated by the senior author (O.A.) between 1998 and 2016. Meningiomas extending into the optic canal from the intracranial cavity (i.e., clinoid, sphenoid wing, tuberculum sellae, diaphragma sellae) were excluded. Diagnosis was based on ophthalmological, radiological, and intraoperative findings, which were confirmed by the typical histological findings. Preoperative, postoperative, and follow-up visual assessments were performed by neuro-ophthalmologists in all cases.

RESULTS

The patients included 7 females and 1 male. The mean age at diagnosis was 45.1 years (range 25.0–70.0 years). Mean duration of follow-up was 38.9 months (range 3.0–88.0 months). All patients reported visual complaints, and all had objective evidence of optic nerve dysfunction. Their evaluation included visual field, visual acuity, funduscopy, and retinal fiber thickness. Total resection was obtained in 4 cases. Comparing preoperative and postoperative visual function revealed that 4 patients had improvement at the last follow-up, 1 patient had stable vision, and 3 patients had decreased function but none had total vision loss. All patients with good preoperative visual acuity maintained this status following surgical treatment. There was no surgical mortality or infection. Operative complications included binocular diplopia in 4 patients, which remitted spontaneously.

CONCLUSIONS

Surgery can play a beneficial role in the primary treatment of ONSM, especially lesions located in the posterior third of the nerve. Total removal can be achieved with vision preservation or improvement, without major surgical complications, especially at early stages of the disease. Patients with good preoperative vision and CSF flow in the optic sheath have better chances of a favorable outcome than those with poor vision.

ABBREVIATIONS GTR = gross-total resection; ONSM = optic nerve sheath meningioma.

Article Information

Correspondence Ossama Al-Mefty: Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. almeftyossama@bwh.harvard.edu.

INCLUDE WHEN CITING Published online September 21, 2018; DOI: 10.3171/2018.4.JNS173080.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Postcontrast T1-weighted MRI studies. Left: Oblique view depicting a meningioma along the posterior third of the right optic nerve. Right: Coronal view showing the radial distribution of the tumor along the optic nerve circumference.

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    Postcontrast axial T1-weighted MRI studies revealing intracanalicular lesions. A: Tumor extending into the posterior third of the optic nerve. B: Tumor extending into the middle third of the optic nerve. C: Tumor extending into the anterior third of the optic nerve. D: Bilateral involvement of the optic nerve by tumor.

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    Axial diffusion-weighted imaging studies. Left: Preoperative image showing a hyperintense signal in the anterior portion of the optic nerve (white arrow), suggesting ischemia. Right: Postoperative image disclosing the same sign along the whole length of the nerve.

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    Anatomical dissections of a left optic nerve and sheath. Upper: Opening the optic sheath reveals a dense arachnoidal trabeculae (arrowheads) serving as a barrier between the dura and the vasculature of the optic nerve. Asterisks in both images indicate the eye globe. Lower: After removing the trabeculae, one can identify, in the inferolateral aspect of the nerve, the central retinal artery (arrowhead) and its branches. Copyright Ossama Al-Mefty. Published with permission.

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    T2-weighted MRI studies. Left: Axial view revealing an intracanalicular tumor (asterisk) with dilation of the distal subarachnoid space (arrows). Right: The same phenomena can be observed in a coronal plane (arrows).

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    Artistic representation of the right orbit, superior view, where a tumor (light red) is occupying the optic canal and extending to the posterior third of the intraconal optic nerve, just before the central retinal artery (seen crossing below the nerve). The four forms of ONSMs: I, type 1; II, type 2; III, type 3; IV, type 4. Yellow indicates the optic nerve; blue, CSF at the subarachnoid space; red, tumor; gray, dura (optic nerve sheath). Copyright Anil Can. Published with permission.

  • View in gallery

    Intraoperative photographs of an intracanalicular ONSM extending to the posterior third of the optic nerve; the anterior clinoid was removed and the optic sheath was opened. Left: Tumor (T) location in relation to the eye globe (asterisks). Right: An intact arachnoidal plane is identified (arrowheads).

References

  • 1

    Abouaf LGirard NLefort TD’hombres ATilikete CVighetto A: Standard-fractionated radiotherapy for optic nerve sheath meningioma: visual outcome is predicted by mean eye dose. Int J Radiat Oncol Biol Phys 82:126812772012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Adams GRoos DECrompton JL: Radiotherapy for optic nerve sheath meningioma: a case for earlier intervention? Clin Oncol (R Coll Radiol) 25:3563612013

  • 3

    Al-Mefty O: The supraorbital approach to tuberculum sellae meningiomas in Al-Mefty O (ed): Operative Atlas of Meningiomas. Philadelphia: Lippincott-Raven1998 pp 3057

    • Search Google Scholar
    • Export Citation
  • 4

    Bloch OSun MKaur GBarani IJParsa AT: Fractionated radiotherapy for optic nerve sheath meningiomas. J Clin Neurosci 19:121012152012

  • 5

    Brower JVAmdur RJKirwan JMendenhall WMFriedman W: Radiation therapy for optic nerve sheath meningioma. Pract Radiat Oncol 3:2232282013

  • 6

    Cantore WA: Neural orbital tumors. Curr Opin Ophthalmol 11:3673712000

  • 7

    Castel ABoschi ARenard LDe Potter P: Optic nerve sheath meningiomas: clinical features, functional prognosis and controversial treatment. Bull Soc Belge Ophtalmol 275:73782000

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Charpentier PMouriaux F: Total recovery of optic nerve sheath meningioma. BMJ Case Rep 2016:2155322016

  • 9

    Clark WCTheofilos CSFleming JC: Primary optic nerve sheath meningiomas. Report of nine cases. J Neurosurg 70:37401989Pubmed

  • 10

    Craig WMGogela LJ: Intraorbital meningiomas; a clinicopathologic study. Am J Ophthalmol 32:166316801949

  • 11

    Craig WMGogela LJ: Meningioma of the optic foramen as a cause of slowly progressive blindness; report of three cases. J Neurosurg 7:44481950

  • 12

    Cristante L: Surgical treatment of meningiomas of the orbit and optic canal: a retrospective study with particular attention to the visual outcome. Acta Neurochir (Wien) 126:27321994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Cushing HEisenhardt L: Meningiomas. Their Classification, Regional Behaviour, Life History, and Surgical End Results. Springfield, IL: Charles C. Thomas1938

    • Export Citation
  • 14

    Dandy WE: Prechiasmal intracranial tumors of the optic nerves. Am J Ophthalmol 5:1691881922

  • 15

    Dutton JJ: Optic nerve sheath meningiomas. Surv Ophthalmol 37:1671831992

  • 16

    Ebers GCGirvin JPCanny CB: A ‘possible’ optic nerve meningioma. Arch Neurol 37:7817831980

  • 17

    Egan RALessell S: A contribution to the natural history of optic nerve sheath meningiomas. Arch Ophthalmol 120:150515082002Pubmed

  • 18

    Fineman MSAugsburger JJ: A new approach to an old problem. Surv Ophthalmol 43:5195241999

  • 19

    Francois JNeetens ACollette JM: Vascularization of the primary optic pathways. Br J Ophthalmol 42:65801958

  • 20

    Hashiba THashimoto NIzumoto SSuzuki TKagawa NMaruno M: Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas. J Neurosurg 110:6756842009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Ito MIshizawa AMiyaoka MSato KIshii S: Intraorbital meningiomas. Surgical management and role of radiation therapy. Surg Neurol 29:4484531988

  • 22

    Kennerdell JSMaroon JCMalton MWarren FA: The management of optic nerve sheath meningiomas. Am J Ophthalmol 106:4504571988

  • 23

    Killer HEJaggi GPFlammer JMiller NRHuber ARMironov A: Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? Brain 130:5145202007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Killer HELaeng HRFlammer JGroscurth P: Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol 87:7777812003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Kim JWRizzo JFLessell S: Controversies in the management of optic nerve sheath meningiomas. Int Ophthalmol Clin 45:15232005

  • 26

    Kuroda RNakatani JYorimae ANakao YOhtori T: Clinical experience of intraorbital optic nerve sheath meningioma—report of eight cases. Neurol Med Chir (Tokyo) 30:4684751990

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Lee JHJeun SSEvans JKosmorsky G: Surgical management of clinoidal meningiomas. Neurosurgery 48:101210212001

  • 28

    Mark LEKennerdell JSMaroon JCRosenbaum AEHeinz RJohnson BL: Microsurgical removal of a primary intraorbital meningioma. Am J Ophthalmol 86:7047091978

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Massof RW: The measurement of vision disability. Optom Vis Sci 79:5165522002

  • 30

    Miller NR: Primary tumours of the optic nerve and its sheath. Eye (Lond) 18:102610372004

  • 31

    Miller NR: Radiation for optic nerve meningiomas: is this the answer? Ophthalmology 109:8338342002

  • 32

    Moster ML: Detection and treatment of optic nerve sheath meningioma. Curr Neurol Neurosci Rep 5:3673752005

  • 33

    Ortiz OSchochet SSKotzan JMKostick D: Radiologic-pathologic correlation: meningioma of the optic nerve sheath. AJNR Am J Neuroradiol 17:9019061996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Roser FNakamura MMartini-Thomas RSamii MTatagiba M: The role of surgery in meningiomas involving the optic nerve sheath. Clin Neurol Neurosurg 108:4704762006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Saeed PRootman JNugent RAWhite VAMackenzie IRKoornneef L: Optic nerve sheath meningiomas. Ophthalmology 110:201920302003

  • 36

    Samarawickrama CFrydenberg EWells MSteel TGhabrial R: An unusual radiological presentation of optic nerve sheath meningioma. Saudi J Ophthalmol 30:1371392016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Schick UDott UHassler W: Surgical management of meningiomas involving the optic nerve sheath. J Neurosurg 101:9519592004Pubmed

  • 38

    Schick UHassler W: Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 76:9779832005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Shapey JSabin HIDanesh-Meyer HVKaye AH: Diagnosis and management of optic nerve sheath meningiomas. J Clin Neurosci 20:104510562013

  • 40

    Shields JAShields CLScartozzi R: Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1. Ophthalmology 111:99710082004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Shuangshoti S: Meningioma of the optic nerve. Br J Ophthalmol 57:2652691973

  • 42

    Smee RISchneider MWilliams JR: Optic nerve sheath meningiomas—non-surgical treatment. Clin Oncol (R Coll Radiol) 21:8132009

  • 43

    Smith JLVuksanovic MMYates BMBienfang DC: Radiation therapy for primary optic nerve meningiomas. J Clin Neuroophthalmol 1:85991981

  • 44

    Spencer WH: Primary neoplasms of the optic nerve and its sheaths: clinical features and current concepts of pathogenetic mechanisms. Trans Am Ophthalmol Soc 70:4905281972

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Susac JOSmith JLWalsh FB: The impossible meningioma. Arch Neurol 34:36381977

  • 46

    Tsutsumi SRhoton AL Jr: Microsurgical anatomy of the central retinal artery. Neurosurgery 59:8708792006

  • 47

    Turbin REThompson CRKennerdell JSCockerham KPKupersmith MJ: A long-term visual outcome comparison in patients with optic nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapy. Ophthalmology 109:8909002002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    Verheggen RMarkakis EMühlendyck HFinkenstaedt M: Symptomatology, surgical therapy and postoperative results of sphenoorbital, intraorbital-intracanalicular and optic sheath meningiomas. Acta Neurochir Suppl 65:95981996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Walsh FB: Abnormalities of the optic disc. Am J Ophthalmol 32:9931949

  • 50

    Wright JE: Primary optic nerve meningiomas: clinical presentation and management. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol 83:6176251977

  • 51

    Wright JECall NBLiaricos S: Primary optic nerve meningioma. Br J Ophthalmol 64:5535581980

  • 52

    Wright JEMcNab AAMcDonald WI: Primary optic nerve sheath meningioma. Br J Ophthalmol 73:9609661989

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