Abstract
Background The management of optic nerve sheath meningiomas (ONSMs) remains controversial. Surgical
decompression through traditional resective techniques has been associated with significant
morbidity. While radiation therapy, the current modality of choice is not exempt of
risks.
Transnasal endoscopic optic nerve decompression (EOND) offers a direct route to the
orbit, optic canal, and orbital apex, providing a minimally invasive alternative.
Objective The main objective of this article is to assess EOND as the initial management of
symptomatic patients with primary ONSM.
Methods Patients with ONSMs without a history of radiotherapy who underwent EOND were retrospectively
reviewed. Postoperative imaging, duration of follow-up, and visual outcomes at the
last ophthalmology visit were assessed.
Results Four women (age range 25–63 years) with primary ONSMs that underwent EOND were identified.
All patients displayed subjective and objective baseline signs of vision loss. Additionally,
baseline proptosis, diplopia, optic nerve atrophy, and ocular pain were identified.
In none of the cases, the optic nerve sheath was breached.
Following EOND, all patients deferred treatment with adjuvant radiotherapy. At a mean
postoperative follow-up of 14 months, all patients were clinically stable without
evidence of disease progression on imaging or physical examination. At last ophthalmologic
evaluation, three out of four showed objective improvements from baseline visual acuity
and visual field (remaining patient had baseline optic nerve atrophy).
Conclusion These results suggest that EOND could be a viable initial treatment modality of selected
primary ONSM cases. Further studies are warranted to determine long-term efficacy
and its role in a stepwise progression of management, preceding radiotherapy.
Keywords
orbital tumors - optic nerve sheath meningiomas - endoscopic endonasal approach -
endoscopic optic nerve decompression
