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Jun 21, 2019
I'm curious about something. How does a 1 x 2 mm tumor cause displacement of the optic nerve? I am imagining that this could only happen if the tumor arose in the optic canal, and caused, as a result of compression of the optic nerve along this confined segment of the optic nerve. If this supposition is correct, a neurosurgical 'unroofing' of the optic canal might provide immediate benefit. I do not advocate for surgical management of the tumor, as disruption of the vasa nervorum would lead to an irreversible optic nerve injury. I advocate radiation therapy to a dose of 50.4 Gy with an emphasis on dose homogeneity within the small irradiated volume, and the use of daily image guidance to assure accurate treatment delivery.
Aug 23, 2019
I want review of mri by radiologist. if patient has optic nerve sheat meningioma my recommendation is radiation therapy with IMRT to a dose 45 to 50.4 .
Nov 17, 2019
Clearly needs IMRT to preserve residual vision in RE but like Dr Knisely I cant see such a tiny meningionlma causing such disruption of the optic nerve function.
May 21, 2021
MRI with anaesthesia may give a better view as the slightest eye movements degrade the MRI views
Jul 06, 2022
Pending Moderator approval.
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