2018 - 1 Issue

Original article

Orbital optic nerve sheath meningioma

Alena Furdová
Pavel Babál – Daniela Kobzová

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DOI: 10.31348/2018/1/4-1-2018

Published in Czech and Slovak Ophtalmology: 2018 - 1

Published on website: 03.07.2018

Keywords: meningioma of the orbit, primary tumors of the orbit, secondary tumors of the orbit, enucleation, exenteration with lid sparing technique

Summary

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 years
after 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.

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