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Perhaps because of its innate, precarious blood supply, clinical experience has shown that the anterior visual pathways are especially sensitive to high doses of ionizing radiation. As a result, the risk of radiation injury to the optic nerves has engendered considerable angst in the setting of stereotactic radiosurgery (SRS). The general consensus has been that the likelihood of complications involving the optic nerves increases significantly at doses greater than 12 Gy [1]. However, this rule of thumb pays little credence to the near-universal concept within radiosurgery of the "volume effect". The current case demonstrates the importance of considering not just dose, but also volume, when assessing the risk of radiation-induced optic neuropathy. To the best of our knowledge, this case report documents the highest dose of ionizing radiation given to any portion of the anterior visual pathway without apparent injury.

Extreme Tolerance of the Optic Nerve to Ionizing Radiation: A Case Report Revealing the Role of the Dose-Volume Effect