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Radiotherapy can maintain sight in optic nerve sheath meningioma

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Patients who need treatment for primary optic nerve sheath meningioma (ONSM) may be spared the blindness that follows surgery with a treatment which has proved successful in the largest series of patients studied so far.

The study of 15 patients used stereotactic fractionated conformal radiotherapy to treat ONSM and halt its spread. At a mean follow up of 37 months (range 12–71 months) the tumour had not progressed in any patient. Sight was maintained and, indeed, vision improved in seven patients—who had larger visual field (⩾8%)—and one with greater visual acuity (⩾2 lines). The procedure provoked only local reddening and local hair loss, which reversed with time, and hyperprolactinaemia (two patients) and partial hypophyseal insufficiency (one).

Twelve patients were women (mean age 51.5 years) and three were men (mean age 35 years). Systemic disease was excluded, and ONSM was confirmed by biopsy (three patients) or MRI or computed tomography (12). Each patient had a thorough eye examination and tests for acuity and visual fields. All patients received 54 Gy total irradiation in 28 fractions during 5.5 weeks. They were followed up closely, with eye examinations, radio-oncological and endocrine tests, and MRI scans.

Primary ONSM is rare but nearly always results in blindness—whether left alone or surgically treated when it starts to affect surrounding tissues. This alternative treatment is a major advance. The study’s authors recommend it for all stages of ONSM, to stand the best chance of maintaining eyesight, though only longer follow up will tell whether the tumours eventually recur.

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