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Benign Tumors
Optic Nerve Sheath Meningioma
Optic Nerve Sheath Meningioma
Daniel E. Meltzer, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Optic nerve sheath meningioma (ONSM)

              • Synonyms

                • Perioptic meningioma

              • Definitions

                • Benign, slow-growing neoplasm of optic nerve (ON) dural sheath
                • Distinct entity from intracranial (sphenoorbital) meningioma that extends through orbital apex
                  • 90% of meningiomas that involve orbit are secondary lesions rather than primary ONSM

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Arnold AC et al: Dilation of the perioptic subarachnoid space anterior to optic nerve sheath meningioma. J Neuroophthalmol. 41(1):e100-2, 2020
                                              2. Interlandi E et al: Optical coherence tomography angiography findings in optic nerve sheath meningioma. Case Rep Ophthalmol. 11(2):364-9, 2020
                                              3. Eckert F et al: Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas. Radiat Oncol. 14(1):240, 2019
                                              4. Conti A et al: CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations. Springerplus. 4:37, 2015
                                              5. Vanikieti K et al: Pediatric primary optic nerve sheath meningioma. Int Med Case Rep J. 8:159-63, 2015
                                              6. Shapey J et al: Diagnosis and management of optic nerve sheath meningiomas. J Clin Neurosci. 20(8):1045-56, 2013
                                              7. Marchetti M et al: Multisession radiosurgery for optic nerve sheath meningiomas--an effective option: preliminary results of a single-center experience. Neurosurgery. 2011 Nov;69(5):1116-22; discussion 1122-3. Erratum in: Neurosurgery. 69(6):1321, 2011
                                              8. Romanelli P et al: Staged image guided robotic radiosurgery for optic nerve sheath meningiomas. Comput Aided Surg. 16(6):257-66, 2011
                                              9. Milker-Zabel S et al: Fractionated stereotactic radiation therapy in the management of primary optic nerve sheath meningiomas. J Neurooncol. 94(3):419-24, 2009
                                              10. Wilhelm H: Primary optic nerve tumours. Curr Opin Neurol. 22(1):11-8, 2009
                                              11. Harold Lee HB et al: Primary optic nerve sheath meningioma in children. Surv Ophthalmol. 53(6):543-58, 2008
                                              12. Eddleman CS et al: Optic nerve sheath meningioma: current diagnosis and treatment. Neurosurg Focus. 23(5):E4, 2007
                                              13. Miller NR: New concepts in the diagnosis and management of optic nerve sheath meningioma. J Neuroophthalmol. 26(3):200-8, 2006
                                              14. Jackson A et al: Intracanalicular optic nerve meningioma: a serious diagnostic pitfall. AJNR Am J Neuroradiol. 24(6):1167-70, 2003
                                              15. Narayan S et al: Preliminary visual outcomes after three-dimensional conformal radiation therapy for optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys. 56(2):537-43, 2003
                                              16. Saeed P et al: Optic nerve sheath meningiomas. Ophthalmology. 110(10):2019-30, 2003
                                              17. Andrews DW 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. 51(4):890-902; discussion 903-4, 2002
                                              18. Becker G et al: Stereotactic fractionated radiotherapy in patients with optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys. 54(5):1422-9, 2002
                                              19. Egan RA et al: A contribution to the natural history of optic nerve sheath meningiomas. Arch Ophthalmol. 120(11):1505-8, 2002
                                              20. Liu JK et al: Optic nerve sheath meningiomas: visual improvement after stereotactic radiotherapy. Neurosurgery. 50(5):950-5; discussion 955-7, 2002
                                              21. Pitz S et al: Stereotactic fractionated irradiation of optic nerve sheath meningioma: a new treatment alternative. Br J Ophthalmol. 86(11):1265-8, 2002
                                              22. Turbin RE et al: A long-term visual outcome comparison in patients with optic nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapy. Ophthalmology. 109(5):890-9; discussion 899-900, 2002
                                              23. Moyer PD et al: Treatment of optic nerve sheath meningioma with three-dimensional conformal radiation. Am J Ophthalmol. 129(5):694-6, 2000
                                              24. Delfini R et al: Primary benign tumors of the orbital cavity: comparative data in a series of patients with optic nerve glioma, sheath meningioma, or neurinoma. Surg Neurol. 45(2):147-53; discussion 153-4, 1996
                                              25. Laitt RD et al: Cystic optic nerve meningioma presenting with acute proptosis. Eye. 10 ( Pt 6):744-6, 1996
                                              26. Liauw L et al: Optic nerve glioma mimicking an optic nerve meningioma. Clin Neurol Neurosurg. 98(3):258-61, 1996
                                              27. Ortiz O et al: Radiologic-pathologic correlation: meningioma of the optic nerve sheath. AJNR Am J Neuroradiol. 17(5):901-6, 1996
                                              28. Kaplan RD et al: MR characteristics of meningioma subtypes at 1.5 tesla. J Comput Assist Tomogr. 16(3):366-71, 1992
                                              29. Lindblom B et al: Perioptic cyst distal to optic nerve meningioma: MR demonstration. AJNR Am J Neuroradiol. 13(6):1622-4, 1992
                                              30. Elster AD et al: Meningiomas: MR and histopathologic features. Radiology. 170(3 Pt 1):857-62, 1989
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Optic nerve sheath meningioma (ONSM)

                                                          • Synonyms

                                                            • Perioptic meningioma

                                                          • Definitions

                                                            • Benign, slow-growing neoplasm of optic nerve (ON) dural sheath
                                                            • Distinct entity from intracranial (sphenoorbital) meningioma that extends through orbital apex
                                                              • 90% of meningiomas that involve orbit are secondary lesions rather than primary ONSM

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Arnold AC et al: Dilation of the perioptic subarachnoid space anterior to optic nerve sheath meningioma. J Neuroophthalmol. 41(1):e100-2, 2020
                                                                                          2. Interlandi E et al: Optical coherence tomography angiography findings in optic nerve sheath meningioma. Case Rep Ophthalmol. 11(2):364-9, 2020
                                                                                          3. Eckert F et al: Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas. Radiat Oncol. 14(1):240, 2019
                                                                                          4. Conti A et al: CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations. Springerplus. 4:37, 2015
                                                                                          5. Vanikieti K et al: Pediatric primary optic nerve sheath meningioma. Int Med Case Rep J. 8:159-63, 2015
                                                                                          6. Shapey J et al: Diagnosis and management of optic nerve sheath meningiomas. J Clin Neurosci. 20(8):1045-56, 2013
                                                                                          7. Marchetti M et al: Multisession radiosurgery for optic nerve sheath meningiomas--an effective option: preliminary results of a single-center experience. Neurosurgery. 2011 Nov;69(5):1116-22; discussion 1122-3. Erratum in: Neurosurgery. 69(6):1321, 2011
                                                                                          8. Romanelli P et al: Staged image guided robotic radiosurgery for optic nerve sheath meningiomas. Comput Aided Surg. 16(6):257-66, 2011
                                                                                          9. Milker-Zabel S et al: Fractionated stereotactic radiation therapy in the management of primary optic nerve sheath meningiomas. J Neurooncol. 94(3):419-24, 2009
                                                                                          10. Wilhelm H: Primary optic nerve tumours. Curr Opin Neurol. 22(1):11-8, 2009
                                                                                          11. Harold Lee HB et al: Primary optic nerve sheath meningioma in children. Surv Ophthalmol. 53(6):543-58, 2008
                                                                                          12. Eddleman CS et al: Optic nerve sheath meningioma: current diagnosis and treatment. Neurosurg Focus. 23(5):E4, 2007
                                                                                          13. Miller NR: New concepts in the diagnosis and management of optic nerve sheath meningioma. J Neuroophthalmol. 26(3):200-8, 2006
                                                                                          14. Jackson A et al: Intracanalicular optic nerve meningioma: a serious diagnostic pitfall. AJNR Am J Neuroradiol. 24(6):1167-70, 2003
                                                                                          15. Narayan S et al: Preliminary visual outcomes after three-dimensional conformal radiation therapy for optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys. 56(2):537-43, 2003
                                                                                          16. Saeed P et al: Optic nerve sheath meningiomas. Ophthalmology. 110(10):2019-30, 2003
                                                                                          17. Andrews DW 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. 51(4):890-902; discussion 903-4, 2002
                                                                                          18. Becker G et al: Stereotactic fractionated radiotherapy in patients with optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys. 54(5):1422-9, 2002
                                                                                          19. Egan RA et al: A contribution to the natural history of optic nerve sheath meningiomas. Arch Ophthalmol. 120(11):1505-8, 2002
                                                                                          20. Liu JK et al: Optic nerve sheath meningiomas: visual improvement after stereotactic radiotherapy. Neurosurgery. 50(5):950-5; discussion 955-7, 2002
                                                                                          21. Pitz S et al: Stereotactic fractionated irradiation of optic nerve sheath meningioma: a new treatment alternative. Br J Ophthalmol. 86(11):1265-8, 2002
                                                                                          22. Turbin RE et al: A long-term visual outcome comparison in patients with optic nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapy. Ophthalmology. 109(5):890-9; discussion 899-900, 2002
                                                                                          23. Moyer PD et al: Treatment of optic nerve sheath meningioma with three-dimensional conformal radiation. Am J Ophthalmol. 129(5):694-6, 2000
                                                                                          24. Delfini R et al: Primary benign tumors of the orbital cavity: comparative data in a series of patients with optic nerve glioma, sheath meningioma, or neurinoma. Surg Neurol. 45(2):147-53; discussion 153-4, 1996
                                                                                          25. Laitt RD et al: Cystic optic nerve meningioma presenting with acute proptosis. Eye. 10 ( Pt 6):744-6, 1996
                                                                                          26. Liauw L et al: Optic nerve glioma mimicking an optic nerve meningioma. Clin Neurol Neurosurg. 98(3):258-61, 1996
                                                                                          27. Ortiz O et al: Radiologic-pathologic correlation: meningioma of the optic nerve sheath. AJNR Am J Neuroradiol. 17(5):901-6, 1996
                                                                                          28. Kaplan RD et al: MR characteristics of meningioma subtypes at 1.5 tesla. J Comput Assist Tomogr. 16(3):366-71, 1992
                                                                                          29. Lindblom B et al: Perioptic cyst distal to optic nerve meningioma: MR demonstration. AJNR Am J Neuroradiol. 13(6):1622-4, 1992
                                                                                          30. Elster AD et al: Meningiomas: MR and histopathologic features. Radiology. 170(3 Pt 1):857-62, 1989