Fifty patients with optic nerve sheath meningiomas have been reviewed with a follow-up of up to 15 years. The median age at onset of their symptoms was 40.0 years. The majority were middle aged females with a slowly progressive lesion. More aggressive lesions were encountered in a younger, predominantly male group of patients with frequent intracranial involvement. Our experience indicates that a more aggressive surgical approach to these lesions is needed to prevent this sequence of events. Meningiomas in older individuals often do not need treatment, though radiotherapy can be beneficial.