Czech and Slovak Ophthalmology 45 10.31348/2018/1/4-1-2018 Original article Orbital optic nerve sheath meningioma Furdová Alena Babál Pavel Kobzová Daniela 3 7 2018 1 4-1-2018

Introduction: Orbital meningioma treatment has achieved significant success over the last period. Primary optic nerve sheath meningiomas by the clinically progressive finding, but still persistent sufficient visual acuity, can be treated by fractionated stereotactic radiotherapy. Surgery is indicated for secondary meningiomas of the orbit. Surgical treatment is indicated due to intracranial tumor propagation of meningioma from the chiasm towards the orbit. Material and methods: In the period 2014 - 2016 we monitored in dispensary 15 patients with meningioma of the orbit, who were checked at least in yearly intervals and underwent magnetic resonance examination of the orbit and brain. Results: In group of 15 patients with histologically unverified meningioma of the orbit, the surgical solution was indicated in 3 patients. In 14 (93.3%) patients meningiomas were secondary infiltrating orbit from the intracranial part of visual pathways, and in 1 case meningioma was primary arising from the optic nerv. We indicated enucleation and partial exenteration in 3 (20%) patients. Histopathological examination confirmed meningioma - in two cases gr. I., in one patient gr. II. In all of them, more than 5 yearsafter the primary diagnose of the process, the tumor infiltration from the chiasm towards the orbit was the indication for surgery. In one patient with meningioma gr. II in 12 months interval after surgery - exenteration with lid sparing technique, there was a further progression from the sella turcica area and the growth of tumor masses to the area of the orbital conus. Patient underwent secondary surgical reduction of tumor mass of the orbit and treatment with sandostatin. Conclusion: When deciding to treat meningioma, it is necessary to involve multidisciplinary collaboration. Ophthalmology examination is important because further treatment is indicated on the basis of changes in visual function in correlation with the imaging methods. In cases of progression of the tumor with the infiltration of the orbit, resulting in the loss of visual acuity, in certain conditions a radical solution - enucleation with partial exenteration of the orbit, is necessary.

 meningioma of the orbit primary tumors of the orbit secondary tumors of the orbit enucleation exenteration with lid sparing technique References Alper, MG.: Management of primary optic nerve meningiomas. Current status--therapy in controversy. J. Clin. Neuroophthalmol. 1981;1(2):101–17. Andrews, DW., Faroozan, R., Yang, BP., et al.: Fractionated stereotactic radiotherapy for the treatment of optic nerve sheath meningiomas: preliminary observations of 33 optic nerves in 30 patients with historical comparison to observation with or without prior surgery. Neurosurgery. 2002;51(4):890- 902; discussion 903-904. Arvold, ND, Lessell, S., Bussiere, M., et al.: Visual outcome and tumor control after conformal radiotherapy for patients with optic nerve sheath meningioma. Int. J. Radiat. Oncol. Biol. Phys. 2009;75(4):1166–72. Bains, S., Kim, U., Shanti, R.: Orbital melanoma with calcification: A diagnostic dilemma. Indian J. Ophthalmol. 2016;64(12):932–4. Baumert, BG, Villà, S., Studer, G., et al.: Early improvements in vision after fractionated stereotactic radiotherapy for primary optic nerve sheath meningioma. Radiother. Oncol. 2004;72(2):169–74. Bosch, MM, Boltshauser, E., Harpes, P., et al.: Ophthalmologic findings and long-term course in patients with neurofibromatosis type 2. Am. J. Ophthalmol. 2006;141(6):1068–77. Bosch, MM., Wichmann, WW., Boltshauser, E., et al.: Optic nerve sheath meningiomas in patients with neurofibromatosis type 2. Arch. Ophthalmol. Chic. Ill 1960. 2006;124(3):379–85. Chamberlain, MC., Glantz, MJ., Fadul, CE.: Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology. 2007;69(10):969–73. Chamberlain, MC, Tsao-Wei, DD, Groshen, S.: Salvage chemotherapy with CPT-11 for recurrent meningioma. J. Neurooncol. 2006;78(3):271–6. Chynoranský, M., Furdová, A., Oláh, Z.: Exenteration of the orbit. Cesk. Oftalmol. 1994;50(2):92–7. Dutton JJ.: Optic nerve gliomas and meningiomas.: Neurol. Clin. 1991;9(1):163–77. Grunberg, SM, Weiss, MH, Russell, CA., et al.: Long-term administration of mifepristone (RU486): clinical tolerance during extended treatment of meningioma. Cancer Invest. 2006;24(8):727– 33. Hart, WM., Burde, RM., Klingele, TG., et al.: Bilateral optic nerve sheath meningiomas. Arch. Ophthalmol. Chic. Ill 1960. 1980;98(1):149–51. Hirst, LW., Miller, NR., Hodges, FJ., et al.: Sphenoid pneumosinus dilatans. A sign of meningioma originating in the optic canal. Neuroradiology. 1982;22(4):207–10. Kanamalla US.: The optic nerve tram-track sign.: Radiology. 2003;227(3):718–9. Kennerdell, JS., Maroon, JC., Malton, M., et al.: The Management of Optic Nerve Sheath Meningiomas. Am. J. Ophthalmol. 1988;106(4):450–7. Lewis, T., Kingsley, D., Moseley, I.: Do bi - lateral optic nerve sheath meningiomas exist? Br. J. Neurosurg. 1991;5(1):13–8. Lindblom, B., Truwit, CL., Hoyt, WF.: Optic nerve sheath meningioma. Definition of intraorbital, intracanalicular, and intracranial components with magnetic resonance imaging. Ophthalmology. 1992;99(4):560–6. Liu, D., Xu, D., Zhang, Z., et al.: Longterm results of Gamma Knife surgery for optic nerve sheath meningioma. J. Neurosurg. 2010;113 Suppl:28–33. Miller, NR.: New concepts in the dia - gnosis and management of optic nerve sheath meningioma. J. Neuro-Ophthalmol. Off. J. North Am. Neuro-Ophthalmol. Soc. 2006;26(3):200–8. Nanda, A., Bir, SC., Maiti, TK., et al.: Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J. Neurosurg. 2017;126(1):201–11. Ringel, F., Cedzich, C., Schramm, J.: Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery. 2007;60(4 Suppl 2):214-221; discussion 221- 222. Romanelli, P., Wowra, B., Muacevic, A.: Multisession CyberKnife radiosurgery for optic nerve sheath meningiomas. Neurosurg. Focus. 2007;23(6):E11. Roser, F., Nakamura, M., Martini-Thomas, R., et al.: The role of surgery in meningiomas involving the optic nerve sheath. Clin. Neurol. Neurosurg. 2006;108(5):470–6. Saeed, P., Blank, L., Selva, D., et al.: Primary radiotherapy in progressive optic nerve sheath meningiomas: a long- Saeed, P., Rootman, J., Nugent, RA., et al.: Optic nerve sheath meningiomas. Ophthalmology. 2003;110(10):2019–30. Schulz, C., Mathieu, R., Kunz, U., et al.: Treatment of unresectable skull base meningiomas with somatostatin analogs. Neurosurg. Focus. 2011;30(5):E11. Shields, JA., Shields, CL., Scartozzi, R.: Survey of 1264 patients with orbital tumors and simulating lesions. Ophthalmology. 2004;111(5):997–1008. nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapy. Ophthalmology. 2002;109(5):890-899; discussion 899-900. Skorkovská, K., Kollová, A.: Menin - geomy pochev zrakového nervu – přehled současných léčebných možností. Čes. Slov. Neurol. Neurochir. 2012;75/108(4):420–5. Tailor, TD., Gupta, D., Dalley, RW., et al.: Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiogr. Rev. Publ. Radiol. Soc. N. Am. Inc. 2013;33(6):1739–58. Turbin, RE., Thompson, CR., Kennerdell, JS., et al.: A long-term visual outcome comparison in patients with optic term follow-up study. Br. J. Ophthalmol. 2010;94(5):564–8. Vaněčková, M., Seidl, Z.: Možnosti zobrazení očního bulbu, orbity a optického nervu v modalitě magnetické rezonance (MR). Neurol Praxi. 2006;7(3):164–7. Wilson, WB.: Meningiomas of the anterior visual system. Surv. Ophthalmol. 1981;26(3):109–27.