Orbital tumors that are located lateral to the nerve may be resected via a lateral orbitotomy. Lesions superior to the optic nerve are removed using an orbitofrontal cra-niotomy. When the tumor is located below the nerve or medially, a transethmoidal or transmaxillary approach or a transconjunctival approach can be chosen.

Optic nerve sheath meningeomas (■ Fig. 22.1) may be treated with a variety of modalities, depending on the current visual status of the patient. If vision is lost completely, the tumor can be removed totally. When useful visual function is present, fractionated stereotactic radiotherapy is the method of choice (see Chap. 23). From the neurosurgical point of view a histological confirmation should precede this therapeutic option.

Fig. 22.2. a Microscopic view of an intra-axial optic nerve glioma (pilocytic astrocytoma) on the right side. b Intraoperative view after removal of the pilocytic astrocytoma and decompression of the optic nerve

Fig. 22.1. Bilateral optic nerve sheath meningiomas. The CT images show an extensive calcification of the lesions

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