Optic Nerve Sheath Meningioma Follow-up
- Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy, Sr, MD more...
Further Outpatient Care
Outpatient follow-up care of patients with optic nerve sheath meningioma (ONSM) includes visual acuity testing and field testing, in addition to an imaging study in the form of MRI with gadolinium, preferably every year to check for recurrent disease.
Visual loss is the major complication of surgery for ONSM. Surgery is rarely successful unless the ONSM is pedunculated.
In one series by Coke et al, the overall survival rate for all patients at 5 years and 10 years was 87% and 58%, respectively. The 5- and 10-year survival rates for atypical meningiomas were over 85%. For malignant meningiomas, the survival rate is reported to be approximately 60%. All patients in this series had received surgery and high-dose radiation. No difference in survival rate was apparent in patients as a function of dural or cortical invasion. Long-term survival is possible for patients with atypical and malignant meningiomas treated with surgery and postoperative radiation.
In a review from the literature by Black et al, of 417 patients older than 65 years who underwent meningioma surgery, the average 30-day mortality rate was 16%. The complication rate averaged 39%. The series by Milosevic et al included the records of 59 patients who were treated at the Princess Margaret Hospital from 1966-1990 with histologically confirmed intracranial atypical or malignant meningiomas.
Immediately after diagnosis, 24 patients were referred for radiation, and the remainder of the patients was referred after at least 1 recurrence. The extent of the most recent surgery prior to radiation was gross total excision in 17 patients, subtotal excision in 35 patients, biopsy in 3 patients, and none or unknown in 4 patients. All patients received megavoltage radiation to a median dose of 50 Gy.
Disease progressed in 39 patients (66%) after radiation. Of these, 36 patients died of meningioma, and 3 patients were alive after further surgery. The 5-year actuarial overall and cause-specific survivals were 28% and 34%, respectively. Factors that were associated independently with higher cause-specific survival by multivariate analysis include an age younger than 58 years, treatment after 1975, and a radiation dose of 50 Gy or higher. It is recommended that all patients be evaluated for radiotherapy immediately after initial surgery.
Young age, modern imaging and treatment planning techniques, and postoperative radiation dose of at least 50 Gy contribute to improved outcome in patients with atypical or malignant meningiomas.
In a prospective study that compared prognosis in elderly patients (ie, >65 y) to younger patients, Black et al evaluated 114 patients undergoing meningioma resection divided into 2 groups, as follows: 57 patients aged 65-87 years and a control group of 57 patients aged 25-64 years matched by the American Society of Anesthesiology (ASA) status and tumor site.
Operative complications, 30-day mortality, and preoperative and postoperative neurologic status were assessed with follow-up care for 1-3 months. Complication rates in the 2 groups were similar and were low, that is, 7% in the elderly population had a surgical complication compared with 8.8% of younger patients. Excluding asymptomatic deep venous thrombosis (DVT) detected by screening, 3 elderly patients (5.2%) had medical complications compared with 2 control patients (3.5%).
The vast majority of patients (ie, 93% of the elderly group and 89.4% in the control group) experienced either improvement or no change in neurological status at follow-up 1-3 months after surgery.
One death among elderly patients occurred within 30 days, for a mortality rate of 1.8% compared with no mortality in the younger age group. The death was the result of pneumonia 3 weeks after surgery. They attributed the lower morbidity and mortality rates after meningioma surgery in elderly patients to better patient selection and surgical techniques and to better preoperative and postoperative care by health care providers.
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