Hage Rabih, Alapetite Claire, Brisse Hervé, Zuber Kevin, Lecler Augustin, Lot Guillaume, Le Guerinel Caroline, Vignal-Clermont Catherine, Boissonnet Herve
Neuro-ophthalmology Department, Hôpital Fondation A. de Rothschild, Paris, France.
Radiation Oncology Department, and Proton Center Institut Curie, Paris-Orsay, France.
Eye Brain. 2021 Aug 24;13:219-229. doi: 10.2147/EB.S305822. eCollection 2021.
Management of optic nerve sheath meningiomas (ONSM) remains challenging. Photon radiation therapy (PhRT) is the most common treatment for sight-threatening ONSM. Proton beam therapy (PBT) is less commonly used because it is more expensive and because there are questions about its efficacy specifically in relation to ONSM. PBT has the theoretical advantage of reducing radiation exposure to adjacent structures. We report the visual outcome of patients with primary ONSM managed at the Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, and treated with PBT at the Centre de Protonthérapie, Institut Curie, Orsay, France.
We conducted a retrospective review of all patients with primary ONSM who received PBT (either by itself or following surgery) between January 2006 and January 2019. Neuro-ophthalmic examinations were performed at presentation and after radiotherapy, and, when applicable, after surgery. Meningiomas were measured at the time of diagnosis and at each follow-up MRI examination.
Sixty patients (50 women, 10 men; mean age, 45.2±11.1y) were included, of whom 29 underwent surgery. At presentation, 52 (87%) of them had decreased vision (average visual acuity: 0.6 logMAR). Fundus examination showed optic disc swelling (n=27; 46.5%), optic disc pallor (n=22; 37.9%), optic disc cupping (n=2; 3.4%), opto-ciliary shunt (n=8; 13.8%), or choroidal folds (n=5; 8.6%). Otherwise, it was unremarkable (n=7; 12.1%). After treatment, visual function was stable overall. Fundus examination showed pallor (n=47; 83.9%), swelling (n=3; 5.4%), or cupping (n=2; 3.4%) of the optic disc, or was unremarkable (n=5; 8.9%). The visual field of 8 patients worsened, while 3 developed asymptomatic retinal hemorrhages. Tumor shrunk significantly in 8 patients at 1 year after PBT and remained stable in size in all others. Patients with opto-ciliary shunts had significantly worse visual outcome than other patients. Retinal abnormalities were observed in 11 patients during follow-up.
PBT alone or in association with surgery appears to be a safe and efficient treatment for ONSM, reducing the tumor size and stabilizing visual function. The risk of developing radiation retinopathy seems to be higher when patients had upfront surgery.
视神经鞘膜瘤（ONSM）的治疗仍然具有挑战性。光子放射治疗（PhRT）是对视神经鞘膜瘤视力威胁最常用的治疗方法。质子束治疗（PBT）较少使用，因为它更昂贵，并且对于其在视神经鞘膜瘤方面的疗效存在疑问。质子束治疗在理论上具有减少对相邻结构辐射暴露的优势。我们报告了在法国巴黎阿道夫·德·罗斯柴尔德眼科基金会接受治疗并在法国奥赛居里研究所质子治疗中心接受质子束治疗的原发性视神经鞘膜瘤患者的视力结果。
我们对2006年1月至2019年1月期间接受质子束治疗（单独或手术后）的所有原发性视神经鞘膜瘤患者进行了回顾性研究。在就诊时、放疗后以及适用时在手术后进行神经眼科检查。在诊断时和每次随访MRI检查时测量脑膜瘤大小。
纳入60例患者（50例女性，10例男性；平均年龄45.2±11.1岁），其中29例接受了手术。就诊时，其中52例（87%）视力下降（平均视力：0.6 logMAR）。眼底检查显示视盘肿胀（n = 27；46.5%）、视盘苍白（n = 22；37.9%）、视盘杯状凹陷（n = 2；3.4%）、视睫分流（n = 8；13.8%）或脉络膜皱褶（n = 5；8.6%）。否则，眼底检查无异常（n =
