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Long-term efficacy of fractionated conformal radiotherapy for the management of primary optic nerve sheath meningioma
  1. Ravi Pandit1,
  2. Liliana Paris2,
  3. Danielle S Rudich3,
  4. Robert L Lesser3,4,
  5. Mark J Kupersmith5,
  6. Neil R Miller1
  1. 1 Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Instituto de Oftalmologia Dr Gama Pinto, Lisbon, Portugal
  3. 3 Department of Ophthalmology and Visual Science, Yale University, New Haven, Connecticut, USA
  4. 4 Departments of Ophthalmology and Visual Science and Neurology, Yale University, New Haven, Connecticut, USA
  5. 5 New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Neil R Miller, The Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; nrmiller{at}


Background/Aim Fractionated conformal radiotherapy (FCRT) is now used to treat vision-threatening optic nerve sheath meningioma (ONSM), but long-term efficacy and safety data are lacking; the purpose of this study was to assess these key data.

Methods This is a retrospective chart review with prospective follow-up of adult patients treated with FCRT for primary ONSM at four academic medical centres between 1995 and 2007 with ≥10 years of follow-up after treatment.

Results 16 patients were identified with a mean post-treatment follow-up of 14.6 years (range: 10.5–20.7 years). The mean age at symptom onset was 47.6 years (range: 36–60 years). FCRT was performed at a mean of 2.3 years after symptom onset (range: 0.2–14.0 years). At last follow-up, visual acuity had improved or stabilised in 14 of the 16 (88%) patients, and 11 (69%) had retained or achieved ≥20/40. The mean deviation on automated perimetry remained stable (−14.5 dB pretreatment vs −12.2 dB at last follow-up; p=0.68, n=10). Two (11%) patients had persistent pain, proptosis or diplopia, compared with six (38%) pretreatment (p=0.11). Two (13%) patients developed radiation retinopathy more than 6 months after completion of therapy, one (50%) of whom had worse visual acuity compared with pretreatment. No patient developed tumour involvement or radiation damage in the fellow eye.

Conclusion FCRT stabilises or improves visual function in patients with primary ONSM and is associated with a low risk of significant ocular sequelae. This treatment should be considered instead of surgery in patients with primary ONSM who require intervention due to loss of visual sensory and/or ocular motor function.

  • optic nerve
  • colour vision
  • field of vision
  • orbit
  • visual pathway

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  • Contributors All contributors to this paper meet the authorship criteria and are included in the author list.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Johns Hopkins IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from this study.

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