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The management of optic nerve sheath meningeoma has been controversial and difficult. The conservative strategy was "to wait and see" until the patient became blind on the affected eye. Surgical excision had poor outcome and, with the exception of a few anecdotal case stories, led to blindness or postoperative eye motility disturbances. It has been long known that radiation therapy can prevent tumour progression, but the end result was very often visual deterioration and blindness. A few recent well documented studies describe how stereotactic fractionated conformal radiotherapy can provide stabilisation or improvement in the visual function in optic nerve sheath meningeoma. This article gives an overview, illustrated by a case story.