Surgical Resection of an Optic Nerve Sheath Meningioma: Relevance of Endoscopic Endonasal Approaches to the Optic Canal

Abstract

Optic nerve sheath meningiomas (ONSMs) account for less than 2% of meningiomas and 1.7% of orbital tumors. Although rare, the management of these tumors is important as unilateral blindness often results in untreated cases. Radiotherapy has emerged as the preferred treatment. However, therapies for ONSMs are controversial due to the variable natural history of the disease and limitations of surgical and radiotherapy options. A 60-year-old woman presented with monocular left diminished color perception and blurred vision. Magnetic resonance imaging demonstrated a homogenously enhancing 5-mm left optic nerve mass with evidence of nerve compression. Conservative management was advised. However, 1 month after diagnosis her visual acuity deteriorated further. Because of the small focal location of the tumor within the optic canal, surgery was considered. Given the tumor's location inferomedial to the optic nerve, an endoscopic endonasal approach to the optic canal was performed. This patient recovered fully with resolution of visual symptoms immediately following surgery. Postoperative imaging 24 hours after surgery demonstrated gross total resection of the tumor; 1 year postoperatively the patient has a normal ophthalmologic examination. This report highlights the value of endoscopic endonasal approaches in the management of select optic canal pathology, otherwise inaccessible via transcranial approaches.

Keywords

optic nerve sheath - meningioma - optic canal - skull base - endoscopic endonasal - minimally invasive

• References

• 1 Castel A, Boschi A, Renard L, De Potter P. Optic nerve sheath meningiomas: clinical features, functional prognosis and controversial treatment. Bull Soc Belge Ophtalmol 2000; 275: 73-78
• 2 Dutton JJ. Optic nerve sheath meningiomas. Surv Ophthalmol 1992; 37 (03) 167-183
• 3 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
• 4 Abouaf L, Girard N, Lefort T. , et al. Standard-fractionated radiotherapy for optic nerve sheath meningioma: visual outcome is predicted by mean eye dose. Int J Radiat Oncol Biol Phys 2012; 82 (03) 1268-1277
• 5 Becker G, Jeremic B, Pitz S. , et al. Stereotactic fractionated radiotherapy in patients with optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys 2002; 54 (05) 1422-1429
• 6 Brower JV, Amdur RJ, Kirwan J, Mendenhall WM, Friedman W. Radiation therapy for optic nerve sheath meningioma. Pract Radiat Oncol 2013; 3 (03) 223-228
• 7 Lesser RL, Knisely JP, Wang SL, Yu JB, Kupersmith MJ. Long-term response to fractionated radiotherapy of presumed optic nerve sheath meningioma. Br J Ophthalmol 2010; 94 (05) 559-563
• 8 Moyer PD, Golnik KC, Breneman J. Treatment of optic nerve sheath meningioma with three-dimensional conformal radiation. Am J Ophthalmol 2000; 129 (05) 694-696
• 9 Paulsen F, Doerr S, Wilhelm H, Becker G, Bamberg M, Classen J. Fractionated stereotactic radiotherapy in patients with optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys 2012; 82 (02) 773-778
• 10 Schick U, Dott U, Hassler W. Surgical management of meningiomas involving the optic nerve sheath. J Neurosurg 2004; 101 (06) 951-959
• 11 Liu D, Xu D, Zhang Z. , et al. Long-term results of Gamma knife surgery for optic nerve sheath meningioma. J Neurosurg 2010; 113 (Suppl): 28-33
• 12 Ditzel Filho LF, Prevedello DM, Jamshidi AO. , et al. Endoscopic endonasal approach for removal of tuberculum sellae meningiomas. Neurosurg Clin N Am 2015; 26 (03) 349-361
• 13 Kulwin C, Schwartz TH, Cohen-Gadol AA. Endoscopic extended transsphenoidal resection of tuberculum sellae meningiomas: nuances of neurosurgical technique. Neurosurg Focus 2013; 35 (06) E6
• 14 Turel MK, Tsermoulas G, Reddy D, Andrade-Barazarte H, Zadeh G, Gentili F. Endonasal endoscopic transsphenoidal excision of tuberculum sellae meningiomas: a systematic review. J Neurosurg Sci 2016; 60 (04) 463-475
• 15 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
• 16 Fernandez-Miranda JC, Pinheiro-Nieto C, Gardner PA, Snyderman CH. Endoscopic endonasal approach for a tuberculum sellae meningioma. J Neurosurg 2012; 32 (Suppl): E8
• 17 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
• 18 Lee JY, Ramakrishnan VR, Chiu AG, Palmer J, Gausas RE. Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall. Clin Neurol Neurosurg 2012; 114 (01) 93-98
• 19 Locatelli M, Carrabba G, Guastella C, Gaini SM, Spagnoli D. Endoscopic endonasal removal of a cavernous hemangioma of the orbital apex. Surg Neurol Int 2011; 2: 58
• 20 Zoli M, Manzoli L, Bonfatti R. , et al. Endoscopic endonasal anatomy of the ophthalmic artery in the optic canal. Acta Neurochir (Wien) 2016; 158 (07) 1343-1350