Optic Nerve Decompression with Release of the Meningo-Orbital Band in Medial Sphenoid Wing Meningiomas Improves and Preserves Visual Acuity

Objectives: Medial sphenoid wing meningiomas often present with reduced vision from compression of the optic nerve. We postulated that optic nerve decompression with bony decompression and release of the meningo-orbital band can result in stable or improved vision.

Methods: Retrospective review of medial meningiomas with optic nerve compression operated in a single unit from 2006 to 2015. Visual acuity was compared pre and post-op.

Results: We identified 18 patients. All had craniotomies.15/18 (83.3%) patients presented with reduced vision. 5 had only light perception in the affected eye. 12/18 (66.7%) of the patients had decompression of the optic nerve including release of the meningo-orbital band. One patient experienced worsening acuity due to hydrocephalus. A third of patients 6/18 (33%) had improvement of their vision with 5/18 (27.8%) having undergone optic nerve decompression. Excluding those who presented with only light perception, this increases to 5/13 (38.5%). 6/12 of those decompressed had stable vision (2 had normal vision preoperatively). Patients who presented with only light perception had no improvement in vision.

Conclusion: In patients with optic nerve compression from medial meningiomas, optic nerve decompression with the release of the meningo-orbital band is useful in preservation of vision. In those decompressed 5/12(41.6%) had improvement and a further 6/12(50%) had stable vision. Optic nerve decompression should be considered before or at early stages of visual loss, as no improvement was demonstrated in those with minimal vision preoperatively.