Clinical Characteristics and Treatment Response to Radiotherapy of Optic Nerve Sheath Meningiomas

by Wang, Silas Lancelot

Recent reports of success with conventional, conformal, and stereotactic radiotherapy in stabilizing or improving visual function in patients with primary optic nerve sheath meningiomas have reduced the controversy surrounding the optimal treatment of these rare tumors. To analyze trends in the clinical presentation and diagnosis of optic nerve sheath meningiomas and to evaluate the effectiveness and side]effect profile of three]dimensional conformal radiotherapy versus other treatment modalities, a retrospective chart review was performed on patients with optic nerve sheath meningiomas treated at The Eye Care Group and at the Department of Therapeutic Radiology, Yale University School of Medicine, in New Haven, CT, up to September 2006. Fourteen patients were identified, with a mean age of 45.6 (range 16] 63). Abnormal color vision and proptosis were less frequent than in historical comparison with published series. Four patients had normal initial imaging, underscoring the importance of clinical suspicion and appropriate imaging protocols. One patient was observed only, and one received surgery as primary treatment. Nine patients were treated with three]dimensional conformal radiotherapy at Yale, one with conformal intensity]modulated radiotherapy at Yale, one with three]dimensional conformal radiotherapy at another center, and one with stereotactic fractionated radiotherapy at another center. The overall visual and radiographic control rate for patients treated with radiotherapy was 100% with one late complication of mild dry]eye syndrome and one of pituitary toxicity. Outcomes in this series compare favorably with those in the published literature.