Optic Nerve Sheath Meningioma

 Optic Nerve Sheath Meningioma

Overview

A meningioma is a tumor that arises from the meninges — the membranes that surround the brain and spinal cord. Although not technically a brain tumor, it is included in this category because it may compress or squeeze the adjacent brain, nerves and vessels. Meningioma is the most common type of tumor that forms in the head.

Most meningiomas grow very slowly, often over many years without causing symptoms. But sometimes, their effects on nearby brain tissue, nerves or vessels may cause serious disability.

Meningiomas occur more commonly in women and are often discovered at older ages, but they may occur at any age.

Because most meningiomas grow slowly, often without any significant signs and symptoms, they do not always require immediate treatment and may be monitored over time.

Symptoms

Signs and symptoms of a meningioma typically begin gradually and may be very subtle at first. Depending on where in the brain or, rarely, spine the tumor is situated, signs and symptoms may include:

*Changes in vision, such as seeing double or blurriness

*Headaches, especially those that are worse in the morning

*Hearing loss or ringing in the ears

*Memory loss

*Loss of smell

*Seizures

*Weakness in your arms or legs

*Language difficulty

When to see a doctor

Most signs and symptoms of a meningioma evolve slowly, but sometimes a meningioma requires emergency care.

Seek emergency care if you have:

*Sudden onset of seizures

*Sudden changes in vision or memory

Make an appointment to see your health care provider if you have persistent signs and symptoms that concern you, such as headaches that worsen over time.

In many cases, because meningiomas do not cause any noticeable signs or symptoms, they are only discovered as a result of imaging scans done for reasons that turn out to be unrelated to the tumor, such as a head injury, stroke or headaches.

Causes

It isn't clear what causes a meningioma. Doctors know that something alters some cells in your meninges to make them multiply out of control, leading to a meningioma tumor.

Whether this occurs because of genes you inherit, hormones (which may be related to the more frequent occurrence in women), the rare instance of prior exposure to radiation or other factors remains largely unknown. There is no solid evidence to support the belief that meningiomas occur because of cellphone use.

Risk factors

Risk factors for a meningioma include:

*Radiation treatment. Radiation therapy that involves radiation to the head may increase the risk of a meningioma.

*Female hormones. Meningiomas are more common in women, leading doctors to believe that female hormones may play a role. Some studies have also suggested a link between breast cancer and meningioma risk related to the role of hormones. Some research suggests that the use of oral birth control and hormone replacement therapy could raise the risk of meningioma growth.

*An inherited nervous system disorder. The rare disorder neurofibromatosis 2 increases the risk of meningioma and other brain tumors.

*Obesity. A high body mass index (BMI) is an established risk factor for many types of cancers, and a higher prevalence of meningiomas among obese people has been observed in several large studies. But the relationship between obesity and meningiomas is not clear.

Complications

A meningioma and its treatment, typically surgery and radiation therapy, can cause long-term complications, including:

*Difficulty concentrating

*Memory loss

*Personality changes

*Seizures

*Weakness

*Sensory changes

*Language difficulty

Your provider can treat some complications and refer you to specialists to help you cope with other complications.

Diagnosis

A meningioma can be difficult to diagnose because the tumor is often slow growing. Symptoms of a meningioma may also be subtle and mistaken for other health conditions or written off as normal signs of aging.

If your provider suspects a meningioma, you may be referred to a doctor who specializes in neurological conditions (neurologist).

To diagnose a meningioma, a neurologist will conduct a thorough neurological exam followed by an imaging test with contrast dye, such as:

*Computerized tomography (CT) scan. CT scans take X-rays that create cross-sectional images of a full picture of your brain. Sometimes an iodine-based dye is used to make the picture easier to read.

*Magnetic resonance imaging (MRI). With this imaging study, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain. MRI scans provide a more-detailed picture of the brain and meningiomas.

In some cases, examination of a sample of the tumor (biopsy) may be needed to rule out other types of tumors and confirm a meningioma diagnosis.

Treatment

The treatment you receive for a meningioma depends on many factors, including:

*The size and location of the meningioma

*The rate of growth or aggressiveness of the tumor

*Your age and overall health

*Your goals for treatment

*Wait-and-see approach

Immediate treatment isn't necessary for everyone with a meningioma. A small, slow-growing meningioma that isn't causing signs or symptoms may not require treatment.

If the plan is not to undergo treatment for meningioma, you'll likely have brain scans periodically to evaluate your meningioma and look for signs that it's growing.

If your provider determines the meningioma is growing and needs to be treated, you have several treatment options.

Surgery

If the meningioma causes signs and symptoms or shows signs that it's growing, your provider may recommend surgery.

Surgeons work to remove the meningioma completely. But because a meningioma may occur near many delicate structures in the brain or spinal cord, it isn't always possible to remove the entire tumor. In those cases, surgeons remove as much of the meningioma as possible.

The type of treatment, if any, you need after surgery depends on several factors.

*If no visible tumor remains, then no further treatment may be necessary. However, you will have periodic follow-up scans.

*If the tumor is benign and only a small piece remains, then your provider may recommend periodic follow-up scans only. In some cases, small leftover tumors may be treated with a form of radiation treatment called stereotactic radiosurgery.

*If the tumor is atypical or malignant, you'll likely need radiation.

Surgery may pose risks including infection and bleeding. The specific risks of your surgery will depend on where your meningioma is located. For instance, surgery to remove a meningioma that occurs around the optic nerve can lead to vision loss. Ask your surgeon about the specific risks of your surgery.

TYPE OF DOCTOR AND DEPARTMENT: Neurology SPECIALIST CAN DIAGNOSE THIS DISEASE.