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J Neurol Surg B Skull Base 2019; 80(06): 568-576
DOI: 10.1055/s-0039-1677689
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Role of Endonasal Endoscopic Optic Nerve Decompression as the Initial Management of Primary Optic Nerve Sheath Meningiomas

Guillermo Maza
1   Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
,
Somasundaram Subramaniam
1   Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
,
Juan C. Yanez-Siller
1   Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
,
Bradley A. Otto
1   Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
,
Daniel M. Prevedello
1   Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
2   Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. Carrau
1   Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
2   Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

23 August 2018

05 December 2018

Publication Date:
10 January 2019 (online)

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Abstract

Background The management of optic nerve sheath meningiomas (ONSMs) remains controversial. Surgical decompression through traditional resective techniques has been associated with significant morbidity. While radiation therapy, the current modality of choice is not exempt of risks.

Transnasal endoscopic optic nerve decompression (EOND) offers a direct route to the orbit, optic canal, and orbital apex, providing a minimally invasive alternative.

Objective The main objective of this article is to assess EOND as the initial management of symptomatic patients with primary ONSM.

Methods Patients with ONSMs without a history of radiotherapy who underwent EOND were retrospectively reviewed. Postoperative imaging, duration of follow-up, and visual outcomes at the last ophthalmology visit were assessed.

Results Four women (age range 25–63 years) with primary ONSMs that underwent EOND were identified. All patients displayed subjective and objective baseline signs of vision loss. Additionally, baseline proptosis, diplopia, optic nerve atrophy, and ocular pain were identified. In none of the cases, the optic nerve sheath was breached.

Following EOND, all patients deferred treatment with adjuvant radiotherapy. At a mean postoperative follow-up of 14 months, all patients were clinically stable without evidence of disease progression on imaging or physical examination. At last ophthalmologic evaluation, three out of four showed objective improvements from baseline visual acuity and visual field (remaining patient had baseline optic nerve atrophy).

Conclusion These results suggest that EOND could be a viable initial treatment modality of selected primary ONSM cases. Further studies are warranted to determine long-term efficacy and its role in a stepwise progression of management, preceding radiotherapy.

Keywords

orbital tumors - optic nerve sheath meningiomas - endoscopic endonasal approach - endoscopic optic nerve decompression

Note

This work was presented as a poster at NASBS, Coronado 2018.


Supplementary Material

 

  • References

  • 1 Shapey J, Sabin HI, Danesh-Meyer HV, Kaye AH. Diagnosis and management of optic nerve sheath meningiomas. J Clin Neurosci 2013; 20 (08) 1045-1056
    CrossrefPubMedGoogle Scholar
  • 2 Dutton JJ. Optic nerve sheath meningiomas. Surv Ophthalmol 1992; 37 (03) 167-183
    CrossrefPubMedGoogle Scholar
  • 3 Rush JA, Younge BR, Campbell RJ, MacCarty CS. Optic glioma. Long-term follow-up of 85 histopathologically verified cases. Ophthalmology 1982; 89 (11) 1213-1219
    CrossrefPubMedGoogle Scholar
  • 4 Chutorian AM, Schwartz JF, Evans RA, Carter S. Optic gliomas in children. Neurology 1964; 14: 83-95
    CrossrefPubMedGoogle Scholar
  • 5 Wright JE. Primary optic nerve meningiomas: clinical presentation and management. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol 1977; 83 (4 Pt 1): 617-625
    PubMedGoogle Scholar
  • 6 Sibony PA, Krauss HR, Kennerdell JS, Maroon JC, Slamovits TL. Optic nerve sheath meningiomas. Clinical manifestations. Ophthalmology 1984; 91 (11) 1313-1326
    CrossrefPubMedGoogle Scholar
  • 7 Wright JE, Call NB, Liaricos S. Primary optic nerve meningioma. Br J Ophthalmol 1980; 64 (08) 553-558
    CrossrefPubMedGoogle Scholar
  • 8 Eddleman CS, Liu JK. Optic nerve sheath meningioma: current diagnosis and treatment. Neurosurg Focus 2007; 23 (05) E4
    PubMedGoogle Scholar
  • 9 Maxwell M, Galanopoulos T, Neville-Golden J, Antoniades HN. Expression of androgen and progesterone receptors in primary human meningiomas. J Neurosurg 1993; 78 (03) 456-462
    CrossrefPubMedGoogle Scholar
  • 10 Wan WL, Geller JL, Feldon SE, Sadun AA. Visual loss caused by rapidly progressive intracranial meningiomas during pregnancy. Ophthalmology 1990; 97 (01) 18-21
    CrossrefPubMedGoogle Scholar
  • 11 Bosch MM, Wichmann WW, Boltshauser E, Landau K. Optic nerve sheath meningiomas in patients with neurofibromatosis type 2. Arch Ophthalmol 2006; 124 (03) 379-385
    CrossrefPubMedGoogle Scholar
  • 12 Saeed P, Rootman J, Nugent RA, White VA, Mackenzie IR, Koornneef L. Optic nerve sheath meningiomas. Ophthalmology 2003; 110 (10) 2019-2030
    CrossrefPubMedGoogle Scholar
  • 13 Charpentier P, Mouriaux F. Total recovery of optic nerve sheath meningioma. BMJ Case Rep 2016; 2016: 2016
    PubMedGoogle Scholar
  • 14 Frisèn L, Royt WF, Tengroth BM. Optociliary veins, disc pallor and visual loss. A triad of signs indicating spheno-orbital meningioma. Acta Ophthalmol (Copenh) 1973; 51 (02) 241-249
    PubMedGoogle Scholar
  • 15 Turbin RE, Pokorny K. Diagnosis and treatment of orbital optic nerve sheath meningioma. Cancer Contr 2004; 11 (05) 334-341
    PubMedGoogle Scholar
  • 16 Misra S, Misra N, Gogri P, Mehta R. A rare case of bilateral optic nerve sheath meningioma. Indian J Ophthalmol 2014; 62 (06) 728-730
    CrossrefPubMedGoogle Scholar
  • 17 Alroughani R, Behbehani R. Optic nerve sheath meningioma masquerading as optic neuritis. Case Rep Neurol Med 2016; 2016: 5419432
    PubMedGoogle Scholar
  • 18 Jackson A, Patankar T, Laitt RD. Intracanalicular optic nerve meningioma: a serious diagnostic pitfall. AJNR Am J Neuroradiol 2003; 24 (06) 1167-1170
    PubMedGoogle Scholar
  • 19 Zhang TL, Shao SF, Zhang T. , et al. Idiopathic inflammation of optic nerve simulating optic nerve sheath meningioma: CT demonstration. J Comput Assist Tomogr 1987; 11 (02) 360-361
    CrossrefPubMedGoogle Scholar
  • 20 Sawaya RA, Sidani C, Farah N, Hourani-Risk R. Presumed bilateral optic nerve sheath meningiomas presenting as optic neuritis. J Neuroophthalmol 2008; 28 (01) 55-57
    CrossrefPubMedGoogle Scholar
  • 21 Mao JF, Xia XB, Tang XB, Zhang XY, Wen D. Analyses on the misdiagnoses of 25 patients with unilateral optic nerve sheath meningioma. Int J Ophthalmol 2016; 9 (09) 1315-1319
    PubMedGoogle Scholar
  • 22 Jiang L, Shi J, Liu W, Kang J, Wang N. [Clinical feature of chronic compressive optic neuropathy without optic atrophy]. [Article in Chinese] Zhonghua Yan Ke Za Zhi 2014; 50 (12) 889-893
    PubMedGoogle Scholar
  • 23 Miller NR. Primary tumours of the optic nerve and its sheath. Eye (Lond) 2004; 18 (11) 1026-1037
    CrossrefPubMedGoogle Scholar
  • 24 Mafee MF, Goodwin J, Dorodi S. Optic nerve sheath meningiomas. Role of MR imaging. Radiol Clin North Am 1999; 37 (01) 37-58 , ix
    CrossrefPubMedGoogle Scholar
  • 25 Gündüz K, Catak E, Erden E. Optic nerve biopsy via a medial transconjunctival orbitotomy approach in the diagnosis of optic nerve and sheath tumors. Orbit 2010; 29 (04) 190-193
    CrossrefPubMedGoogle Scholar
  • 26 Khong JJ, McNab AA. Medial transconjunctival intrinsic optic nerve biopsy: surgical technique and indications. Orbit 2012; 31 (04) 227-232
    CrossrefPubMedGoogle Scholar
  • 27 Kim JW, Rizzo JF, Lessell S. Controversies in the management of optic nerve sheath meningiomas. Int Ophthalmol Clin 2005; 45 (04) 15-23
    CrossrefPubMedGoogle Scholar
  • 28 Saeed P, Tanck MW, Freling N, Baldeschi L, Mourits MP, Bennink RJ. Somatostatin receptor scintigraphy for optic nerve sheath meningiomas. Ophthalmology 2009; 116 (08) 1581-1586
    CrossrefPubMedGoogle Scholar
  • 29 Gehler B, Paulsen F, Oksüz MO. , et al. [68Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning. Radiat Oncol 2009; 4: 56
    CrossrefPubMedGoogle Scholar
  • 30 Klingenstein A, Haug AR, Miller C, Hintschich C. Ga-68-DOTA-TATE PET/CT for discrimination of tumors of the optic pathway. Orbit 2015; 34 (01) 16-22
    CrossrefPubMedGoogle Scholar
  • 31 Berman D, Miller NR. New concepts in the management of optic nerve sheath meningiomas. Ann Acad Med Singapore 2006; 35 (03) 168-174
    PubMedGoogle Scholar
  • 32 Egan RA, Lessell S. A contribution to the natural history of optic nerve sheath meningiomas. Arch Ophthalmol 2002; 120 (11) 1505-1508
    CrossrefPubMedGoogle Scholar
  • 33 Schick U, Jung C, Hassler WE. Primary optic nerve sheath meningiomas: a follow-up study. Cent Eur Neurosurg 2010; 71 (03) 126-133
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Kennerdell JS, Maroon JC, Malton M, Warren FA. The management of optic nerve sheath meningiomas. Am J Ophthalmol 1988; 106 (04) 450-457
    CrossrefPubMedGoogle Scholar
  • 35 Dyke CG, Davidoff LM. Roentgen Treatment of Diseases of the Nervous System. 3rd edition. Philadelphia: Lea & Febiger; 1942: 113
    Google Scholar
  • 36 Turbin RE, Thompson CR, Kennerdell JS, Cockerham KP, Kupersmith MJ. A long-term visual outcome comparison in patients with optic nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapy. Ophthalmology 2002; 109 (05) 890-899 , discussion 899–900
    CrossrefPubMedGoogle Scholar
  • 37 Bloch O, Sun M, Kaur G, Barani IJ, Parsa AT. Fractionated radiotherapy for optic nerve sheath meningiomas. J Clin Neurosci 2012; 19 (09) 1210-1215
    CrossrefPubMedGoogle Scholar
  • 38 Subramanian PS, Bressler NM, Miller NR. Radiation retinopathy after fractionated stereotactic radiotherapy for optic nerve sheath meningioma. Ophthalmology 2004; 111 (03) 565-567
    CrossrefPubMedGoogle Scholar
  • 39 Hamilton SN, Nichol A, Truong P. , et al. Visual outcomes and local control after fractionated stereotactic radiotherapy for optic nerve sheath meningioma. Ophthal Plast Reconstr Surg 2018; 34 (03) 217-221
    CrossrefPubMedGoogle Scholar
  • 40 Metellus P, Kapoor S, Kharkar S. , et al. Fractionated conformal radiotherapy for management of optic nerve sheath meningiomas: long-term outcomes of tumor control and visual function at a single institution. Int J Radiat Oncol Biol Phys 2011; 80 (01) 185-192
    CrossrefPubMedGoogle Scholar
  • 41 Turbin RE, Wladis EJ, Frohman LP, Langer PD, Kennerdell JS. Role for surgery as adjuvant therapy in optic nerve sheath meningioma. Ophthal Plast Reconstr Surg 2006; 22 (04) 278-282
    CrossrefPubMedGoogle Scholar
  • 42 Roser F, Nakamura M, Martini-Thomas R, Samii M, Tatagiba M. The role of surgery in meningiomas involving the optic nerve sheath. Clin Neurol Neurosurg 2006; 108 (05) 470-476
    CrossrefPubMedGoogle Scholar
  • 43 Schick U, Dott U, Hassler W. Surgical management of meningiomas involving the optic nerve sheath. J Neurosurg 2004; 101 (06) 951-959
    CrossrefPubMedGoogle Scholar
  • 44 Norris JH, Norris JS, Akinwunmi J, Malhotra R. Optic canal decompression with dural sheath release; a combined orbito-cranial approach to preserving sight from tumours invading the optic canal. Orbit 2012; 31 (01) 34-43
    CrossrefPubMedGoogle Scholar
  • 45 Adeberg S, Welzel T, Rieken S, Debus J, Combs SE. Prior surgical intervention and tumor size impact clinical outcome after precision radiotherapy for the treatment of optic nerve sheath meningiomas (ONSM). Radiat Oncol 2011; 6: 117
    CrossrefPubMedGoogle Scholar
  • 46 Miller NR. New concepts in the diagnosis and management of optic nerve sheath meningioma. J Neuroophthalmol 2006; 26 (03) 200-208
    CrossrefPubMedGoogle Scholar
  • 47 Hunt PJ, DeMonte F, Tang RA, Su SY, Raza SM. Surgical resection of an optic nerve sheath meningioma: relevance of endoscopic endonasal approaches to the optic canal. J Neurol Surg Rep 2017; 78 (02) e81-e85
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Mark LE, Kennerdell JS, Maroon JC, Rosenbaum AE, Heinz R, Johnson BL. Microsurgical removal of a primary intraorbital meningioma. Am J Ophthalmol 1978; 86 (05) 704-709
    CrossrefPubMedGoogle Scholar
  • 49 Meeker AR, Ko MW, Carruth BP, Strumpf KB, Bersani TA. Diagnosis of optic nerve sheath meningioma during optic nerve sheath decompression. Orbit 2017; 36 (01) 35-38
    CrossrefPubMedGoogle Scholar
  • 50 Levin MH, Ney JJ, Venneti S. , et al. Optic nerve biopsy in the management of progressive optic neuropathy. J Neuroophthalmol 2012; 32 (04) 313-320
    CrossrefPubMedGoogle Scholar
  • 51 Zhao JW, Wang DS, Chang QL. , et al. [Theoretic explanation about visual disorder induced by fibrous dysplasia of skull: pressure disequilibrium between lamina cribrosa]. Zhonghua Yi Xue Za Zhi 2010; 90 (19) 1317-1321
    PubMedGoogle Scholar
  • 52 Sergott RC, Savino PJ, Bosley TM. Optic nerve sheath decompression: a clinical review and proposed pathophysiologic mechanism. Aust N Z J Ophthalmol 1990; 18 (04) 365-373
    CrossrefPubMedGoogle Scholar
  • 53 Luxenberger W, Stammberger H, Jebeles JA, Walch C. Endoscopic optic nerve decompression: the Graz experience. Laryngoscope 1998; 108 (06) 873-882
    CrossrefPubMedGoogle Scholar
  • 54 Jho HD. Endoscopic endonasal approach to the optic nerve: a technical note. Minim Invasive Neurosurg 2001; 44 (04) 190-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Lund VJ, Larkin G, Fells P, Adams G. Orbital decompression for thyroid eye disease: a comparison of external and endoscopic techniques. J Laryngol Otol 1997; 111 (11) 1051-1055
    CrossrefPubMedGoogle Scholar
  • 56 Jacquesson T, Abouaf L, Berhouma M, Jouanneau E. How I do it: the endoscopic endonasal optic nerve and orbital apex decompression. Acta Neurochir (Wien) 2014; 156 (10) 1891-1896
    CrossrefPubMedGoogle Scholar
  • 57 de Lara D, Ditzel Filho LF, Prevedello DM. , et al. Endonasal endoscopic approaches to the paramedian skull base. World Neurosurg 2014; 82 (6, Suppl): S121-S129
    CrossrefPubMedGoogle Scholar
  • 58 Stokken J, Gumber D, Antisdel J, Sindwani R. Endoscopic surgery of the orbital apex: Outcomes and emerging techniques. Laryngoscope 2016; 126 (01) 20-24
    CrossrefPubMedGoogle Scholar
  • 59 Murchison AP, Rosen MR, Evans JJ, Bilyk JR. Endoscopic approach to the orbital apex and periorbital skull base. Laryngoscope 2011; 121 (03) 463-467
    CrossrefPubMedGoogle Scholar
  • 60 McKinney KA, Snyderman CH, Carrau RL. , et al. Seeing the light: endoscopic endonasal intraconal orbital tumor surgery. Otolaryngol Head Neck Surg 2010; 143 (05) 699-701
    CrossrefPubMedGoogle Scholar
  • 61 Pletcher SD, Sindwani R, Metson R. Endoscopic orbital and optic nerve decompression. Otolaryngol Clin North Am 2006; 39 (05) 943-958 , vi vi
    CrossrefPubMedGoogle Scholar
  • 62 Sade B, Lee JH. High incidence of optic canal involvement in tuberculum sellae meningiomas: rationale for aggressive skull base approach. Surg Neurol 2009; 72 (02) 118-123 , discussion 123
    CrossrefPubMedGoogle Scholar
  • 63 Bulters DO, Shenouda E, Evans BT, Mathad N, Lang DA. Visual recovery following optic nerve decompression for chronic compressive neuropathy. Acta Neurochir (Wien) 2009; 151 (04) 325-334
    CrossrefPubMedGoogle Scholar
  • 64 Carlson AP, Stippler M, Myers O. Predictive factors for vision recovery after optic nerve decompression for chronic compressive neuropathy: systematic review and meta-analysis. J Neurol Surg B Skull Base 2013; 74 (01) 20-38
    PubMedGoogle Scholar
  • 65 Tamura R, Takahashi S, Horikoshi T, Yoshida K. Improvement of long-term blindness caused by compression from inner-third sphenoid wing meningioma after optic canal decompression: an extremely rare case report. Surg Neurol Int 2016; 7: 67
    PubMedGoogle Scholar
  • 66 Berhouma M, Jacquesson T, Abouaf L, Vighetto A, Jouanneau E. Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature. Neurosurg Focus 2014; 37 (04) E19
    CrossrefPubMedGoogle Scholar