Optic Nerve Sheath Meningioma Management Strategies

Optic nerve sheath meningiomas (ONSMs) are rare, typically benign tumours that arise from the meningeal coverings of the optic nerve. Management requires a balance between maximising local tumour control and preserving visual function. Traditionally, asymptomatic or slow-growing lesions have been observed with regular imaging and ophthalmic assessment. In patients with progressive visual decline or significant tumour bulk, radiotherapy has become the mainstay of treatment, offering high rates of tumour control with low morbidity. Fractionated stereotactic radiotherapy and hypofractionated regimens have shown durable tumour stabilisation or shrinkage while minimising radiation exposure to adjacent critical structures. Stereotactic radiosurgery, particularly with robotic platforms, provides an alternative in carefully selected cases. Surgical intervention is generally reserved for refractory or large lesions causing compressive symptoms not amenable to safe radiotherapy; advances in minimally invasive endoscopic techniques have broadened the surgical armamentarium. Multidisciplinary decision-making, incorporating neuro-ophthalmology, radiation oncology, neurosurgery and interventional radiology, is essential to tailor treatment to tumour characteristics, patient age and baseline visual function. Emerging strategies focus on refined fractionation schedules, advanced imaging for target definition and the integration of novel radiosurgical platforms to improve functional outcomes.

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Optic Nerve Sheath Meningioma Management Strategies publication trend

The graph below shows the total number of articles in optic nerve sheath meningioma management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Fractionated stereotactic radiotherapy: Highly conformal radiotherapy delivered in multiple small doses using stereotactic localisation.

Hypofractionated stereotactic radiotherapy: Stereotactic radiotherapy delivered in fewer, larger fractions to shorten overall treatment time.

Robotic radiosurgery: Frameless stereotactic radiosurgery using a robotic arm to deliver highly precise radiation beams.

Endoscopic transethmoid approach: A minimally invasive surgical corridor through the nasal cavity and ethmoid sinus to access orbital tumours.

Gross-total resection: Complete surgical removal of visible tumour tissue.

References

1. Role of hypofractionated stereotactic radiotherapy for primary optic nerve sheath meningioma. Neuro-Oncology Practice (2023).
2. Effectiveness and Safety of Robotic Radiosurgery for Optic Nerve Sheath Meningiomas: A Single Institution Series. Cancers (2021).
3. Combined endoscopic transethmoid and transconjunctival en bloc resection of optic nerve tumors in patients lacking functional vision. Frontiers in Oncology (2022).