한국에서의 시신경 수막종 환자의 임상 양상 및 치료 결과
Clinical Features and Management Outcome of Optic Nerve Sheath Meningioma in Korea
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목적: 한국인에서 시신경 수막종 환자들의 임상양상과 치료결과를 알아보고자 하였다. 대상과 방법: 1997년 1월부터 2010년 1월까지 서울대학교 병원에서 시신경 수막종으로 진단받은 환자 10명 10안에 대해 의무기록을 후향적으로 조사하였다. 결과: 환자의 평균 연령은 47.9세, 남여 비율은 2:8이었다. 초기 증상으로 시력저하와 안구돌출이 흔하였고, 종양의 영상 검사소견은 관 모양, 조직병리학 소견은 수막세포성이 가장 흔하였다. 치료 없이 경과 관찰한 2명은 좋은 시력을 유지하며 종양의 더딘 진행을 보였다. 수술을 받은 3명 중 2명에서 시력감소 및 합병증이 동반되었다. 감마나이프 방사선수술을 시행받은 3명은 치료 후 유의한 시력 변화가 관찰되지 않았으며, 종양의 성장이 멈추었다. 3차원 입체조형 방사선치료를 시행받은 2명은 시력 및 시야가 개선되는 소견을 보였고, 종양의 성장이 멈추었다. 결론: 느린 진행이 특징인 대부분의 시신경 수막종 환자에게 보존적 치료를 우선 고려해야 하며, 종양이 빠르게 진행하는 경우 방사선 치료를 최우선으로 고려해야 한다. 적응증에 따라 수술이나 감마나이프 수술을 시도해 볼 수 있다.
Abstract
Purpose: To evaluate the clinical features and treatment results of optic nerve sheath meningioma (ONSM) in Korean patients. Methods: 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. Results: 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. Conclusions: 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.
참고문헌 (19)
- Dutton JJ, "Optic nerve sheath meningiomas", Surv Ophthalmol, 37, pp.167~183 (1992)
- Saeed P, "Optic nerve sheath meningiomas", Ophthalmology, 110, pp.2019~2030 (2003)
- Wright JE, "Primary optic nerve sheath meningioma", Br J Ophthalmol, 73, pp.960~966 (1989)
- Sibony PA, "Optic nerve sheath meningiomas,In clinical manifestations", Ophthalmology, 91, pp.1313~1326 (1984)
- Berman D, "New concepts in the management of optic nerve sheath meningiomas", Ann Acad Med Singapore, 35, pp.168~174 (2006)
- Miller NR, "New concepts in the diagnosis and management of optic nerve sheath meningiomas", J Neuro Ophthalmol, 26, pp.200~208 (2006)
- Probst C, "Primary meningioma of the optic nerve sheaths", Ophthalmologica, 190, pp.83~90 (1985)
- Alper MG, "Management of primary optic meningiomas", Clin Neuroophthalmol, 1, pp.101~117 (1981)
- Hollenhorst RW Jr, "Visual prognosis of optic nerve sheath meningiomas producing shunt vessels on the optic disk: the Hoyt Spencer syndrome", Trans Am Ophthalmol Soc, 75, pp.141~163 (1977)
- Jakobiec FA, "Combined clinical and computed tomographic diagnosis of orbital glioma and meningioma", Ophthalmology, 91, pp.137~155 (1984)
- Rootman J, "Diseases of the orbit,In A multidisciplinary approach", pp.281~285 (1988), JB Lippincott
- Marquardt MD, "Histopathology of meningiomas and gliomas of the optic nerve", Hum Pathol, 13, pp.226~235 (1982)
- Kennerdell JS, "The management of optic nerve sheath meningiomas", Am J Ophthalmol, 106, pp.450~457 (1988)
- Rose GE, "Orbital meningiomas,In surgery, radiotherapy, or hormones", Br J Ophthalmol, 77, pp.313~314 (1993)
- Samples JR, "Optic nerve meningioma", Ophthalmology, 90, pp.1591~1594 (1983)
- Lee AG, "Improvement in visual function in an eye with a presumed optic nerve sheath meningioma after treatment with three dimensional conformal radiation therapy", J Neuroophthalmol, 16, pp.247~251 (1996)
- Moyer PD, "Treatment of optic nerve sheath meningioma with three dimensional conformal radiation", Am J Ophthalmol, 129, pp.694~696 (2000)
- Pitz S, "Stereotactic fractionated irradiation of optic nerve sheath meningioma", Br J Ophthalmol, 86, pp.1265~1268 (2002)
- Saeed P, "Primary radiotherapy in progressive optic nerve sheath meningiomas", Br J Ophthalmol, 94, pp.564~568 (2010)