Berman Dalia, Miller Neil R
The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Ann Acad Med Singap. 2006 Mar;35(3):168-74.
Primary optic nerve sheath meningiomas (ONSMs) are the most common primary tumours of the optic nerve sheath. The diagnosis and management of ONSMs have changed dramatically in the last decade. In this review article, we discuss the latest information regarding these issues.
References for this manuscript were obtained by searching the database PubMed using the phrase "optic nerve sheath meningioma". Approximately 150 articles were identified and reviewed. These articles served as reference sources for other articles, books and chapters on the subject. The results were combined with our personal experience, which includes over 100 cases of ONSMs that have been observed or treated with one or more of the modalities described below.
The diagnosis of ONSM can be suspected in most cases from clinical findings and supported by the results of neuroimaging, obviating tissue biopsy in the majority of cases. Management depends on several factors. Observation may be appropriate in patients with mild or no visual deficit or in whom visual loss is not progressing, whereas stereotactic fractionated radiation therapy has been documented to improve or stabilise vision in progressive or advanced cases. Attempts at excision of ONSMs are associated with a high risk of blindness and should be reserved for the rare case of an anteriorly located, primarily exophytic tumour with focal involvement of the dural sheath. Rare patients with acute visual deterioration may benefit from optic nerve sheath fenestration.
The majority of ONSMs can be suspected on clinical grounds and diagnosed with readily available non-invasive neuroimaging. Stereotactic fractionated radiotherapy is currently the treatment of choice for ONSMs that require therapy.
原发性视神经鞘膜瘤（ONSMs）是视神经鞘最常见的原发性肿瘤。在过去十年中，ONSMs的诊断和治疗发生了巨大变化。在这篇综述文章中，我们讨论了关于这些问题的最新信息。
通过在PubMed数据库中搜索短语“视神经鞘膜瘤”获得本手稿的参考文献。共识别并审阅了约150篇文章。这些文章作为该主题其他文章、书籍和章节的参考来源。结果与我们的个人经验相结合，我们的经验包括观察或治疗过的100多例ONSMs，采用了以下一种或多种方式。
大多数情况下，根据临床发现可怀疑ONSMs的诊断，并得到神经影像学结果的支持，从而在大多数病例中无需进行组织活检。治疗取决于几个因素。对于视力轻度减退或无减退、或视力丧失无进展的患者，观察可能是合适的；而对于进展性或晚期病例，立体定向分次放射治疗已被证明可改善或稳定视力。试图切除ONSMs会导致失明风险很高，应仅用于罕见的位于前部、主要为外生性肿瘤且硬脑膜鞘局部受累的情况。极少数急性视力恶化的患者可能从视神经鞘开窗术中获益。
大多数ONSMs可根据临床情况怀疑，并通过现有的非侵入性神经影像学进行诊断。立体定向分次放射治疗目前是需要治疗的ONSMs的首选治疗方法。
