Stereotactic radiosurgery for optic nerve sheath meningiomas: A comprehensive systematic review and meta-analysis

Abstract

Background: Optic nerve sheath meningiomas (ONSMs) are rare brain neoplastic lesions that account for 2% of meningiomas. Despite the benign and slow-growing behavior of ONSMs, these lesions can result in irreversible blindness. Radiotherapy (RT) is one of the main therapeutic options for the management of ONSMs. Stereotactic radiosurgery (SRS) has demonstrated favorable outcomes in patients with ONSMs. This systematic review and meta-analysis aimed to evaluate local control (LC), preservation of visual field (VF)/visual acuity (VA), and radiation-induced neuropathy/retinopathy.

Methods: On March 17, 2025, four electronic databases, PubMed, Embase, Scopus, and Web of Science, were searched. Studies that evaluated the efficacy and safety of SRS in ONSMs were included.

Results: Seven studies involving 149 patients were included. The mean follow-up duration ranged from 30 to 116.86 months. The meta-analysis reported a pooled LC rate of 95 % (95 % CI: 90 %-98 %). The pooled estimates for VA and VF preservation were 91 % (95 % CI: 76 %-100 %) and 94 % (95 % CI: 68 %-100 %), respectively. Additionally, the meta-analysis found a pooled radiation-induced neuropathy/retinopathy rate of 0 % (95 % CI: 0 %-3%).

Conclusion: SRS demonstrated promising clinical and radiological outcomes in patients with ONSMs. SRS has comparable results to those of the other RT modalities. Further studies with large sample sizes are required to compare SRS and RT modalities.

Keywords: Cyberknife; Gamma knife; Meningioma; Meta-analysis; Optic Nerve; Optic nerve sheath; Radiosurgery.