Elsevier

Ophthalmology

Volume 109, Issue 5, May 2002, Pages 890-899
Ophthalmology

Article for CME Credit
A long-term visual outcome comparison in patients with optic nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapya ,

Presented in part at the annual meeting of the American Academy of Ophthalmology, Dallas, Texas, October 25, 2000.
https://doi.org/10.1016/S0161-6420(02)01017-5Get rights and content

Abstract

Purpose

Comparison of treatment outcome in patients with primary optic nerve sheath meningioma (ONSM).

Design

Retrospective, nonrandomized, comparative interventional case series.

Participants

Sixty-four patients with at least 50 months of well-documented follow-up.

Intervention

Observation, surgery only, radiotherapy only, or surgery and radiotherapy.

Main outcome measures

Visual acuity expressed as ratio, radiographic progression, and treatment complications.

Results

Sixty-four patients (55 women [85.9%] and nine men [14.1%]) were followed for a mean of 150.2 months (range, 51–516 months; standard deviation [SD], 74.7). The mean age at diagnosis was 47.1 years (range, 17–81 years; SD, 15.4). Fifty-eight patients had unilateral disease and six patients had bilateral disease. Of 59 patients with vision greater than no light perception at diagnosis, 13 patients were observed only, 12 had surgery only (four biopsies or partial resections, eight total resections), 18 received radiation alone, and 16 had surgery and radiation (14 biopsies or partial resections and radiation, two total resections and radiation). Irradiated patients received 4000 to 5500 cGy of conventional multiport or conformal external beam therapy, typically fractionated over 6 weeks. Visual acuity measurements at diagnosis among the four groups were not different (ratio, P = 0.186). Visual acuity at diagnosis was ≥0.5 in 56.3%, 0.4 to 0.050 in 12.5%, and <0.050 in 31.3%. Visual acuity measures at last follow-up were different among the four groups (ratio, P = 0.004). At last follow-up the acuity was ≥0.5 in 28.1%, 0.4 to 0.050 in 15.6%, and <0.050 in 56.3%. Visual acuity fell significantly for the observed only (ratio, P = 0.002), surgery only (ratio, P = 0.019), and surgery with radiation groups (ratio, P = 0.030). The radiation only group showed a decrease in visual acuity that was not significant (ratio, P = 0.301). Complication rate was 33.3% in radiation only cases, 66.7% in surgery only cases, and 62.5% in surgery with radiation cases. Twenty-one patients (32.8%) showed radiographic progression. Four patients who were observed, seven patients who had surgery alone, and eight patients who had surgery and radiation developed radiographic progression. Two patients who had radiation alone had radiographic progression before treatment. Only two patients treated with radiation only showed radiographic progression after radiotherapy, and both had at least one surgical procedure before the radiotherapy.

Conclusions

Patients with ONSM receiving radiation alone demonstrated the best visual outcome during the follow-up period. We recommend that fractionated external beam radiation (5000–5500 cGy) be considered as initial treatment in adults in selected cases of ONSM when preservation of visual function is a reasonable therapeutic goal.

Section snippets

Patients and methods

All patients with a clinical history and course suggestive of optic nerve sheath tumor who had radiographic characteristics consistent with ONSM from a referral based University practice (Allegheny General Hospital, Eye and Ear Hospital of Pittsburgh, Dean A. McGee Eye Institute of University of Oklahoma, and New York University) were identified by retrospective chart reviews.13, 14, 15, 16, 17, 18 (Table 1). A subset of these patients was previously reported.12, 19 In addition, cases were

Results

Sixty-four patients were identified with a mean follow-up period of 150.2 months (range, 51–516 months; SD, 74.7). There were 55 women (85.9%) and nine men (14.1%). For the 59 patients used in statistical analysis, the mean follow-up was 138.5 months (range, 57–277 months; SD, 55.4). The diagnosis was confirmed by histopathologic examination in 32 cases. Five of the 64 patients were excluded from statistical analysis because of the NLP vision criterion. Mean age in all patients at diagnosis was

Discussion

In this case series, radiation alone was the only mode of management that did not result in an overall significant decrease in visual acuity when the various visual acuity parameters were subject to outcome analysis at the last follow-up. As noted in Table 7, many patients treated with radiation realized improved function, although this was not significant when visual acuity measures at diagnosis were compared with visual acuity measures at the last follow-up. The power of the treatment effect

Acknowledgements

The authors thank James D. Schlosser, MS and Joyce A. D’Antonio, PhD (Center for Clinical Effectiveness & Outcomes Research, Allegheny General Hospital, Pittsburgh, PA) for statistical analysis. The authors also thank Bradley K. Farris, MD, William R. Rothfus, MD, Floyd A. Warren, MD, Dai Barr, MB, DO, William T. Shults, MD, Mark L. Moster, MD, Richard H. Legge, MD, James Bolling, MD, Robert S. Hepler, MD, William S. Fagman, MD, Mark H. Levy, MD, Myles Behrens, MD, Leon F. Cashwell, MD, Robert

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    Supported, in part, by an Unrestricted Grant from Research to Prevent Blindness, Inc., New York, New York; Fund for the New Jersey Blind, Newark, New Jersey; Lions Eye Research Foundation of New Jersey,Newark, New Jersey; and the Eye Institute of New Jersey, Newark, New Jersey.

    a

    No author has any commercial interest in any of the opinions expressed in this article.

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