To evaluate the clinical features and treatment results of optic nerve sheath meningioma (ONSM) in Korean patients.

The present retrospective noncomparative case series was comprised of 10 eyes of 10 patients with a diagnosis of ONSM who were treated between 1997 and 2010 at the Seoul National University Hospital.

The mean age at presentation was 47.9 years. Two males and 8 females participated in the study. Decreased vision and proptosis were the most common presenting symptoms. On imaging, the most common pattern was tubular. The most common histopathologic pattern was a meningothelial type. Two patients who were observed maintained good vision during the follow-up period and showed a slow progression of the tumor. Two patients out of 3 who underwent surgical management presented significant visual loss and complications. Three patients in the gamma-knife surgery (GKS) group showed no significant changes in visual acuity after treatment; however, tumor growth was halted. Two patients who underwent 3-dimensional conformal radiotherapy (3D-CRT) presented improvement in their visual acuity or visual field, and tumor growth was halted.

Management should be conservative in most cases because of the slow and indolent growth pattern of ONSM. However, 3D-CRT can be considered as an initial treatment in patients with progressive visual deterioration and having still higher possibility of vision maintenance. GKS can be indicated in patients with progressive visual deterioration and a rare possibility of visual recovery. Surgical indications for ONSM are limited and must be carefully considered for each patient.