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Postoperative Reversal of Complete (Monocular) Blindness in Skull Base Meningioma: Case Report

Published online by Cambridge University Press:  02 December 2014

Joseph Bampoe ,
Paul Ranalli  and
Mark Bernstein
Joseph Bampoe
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
Paul Ranalli
Affiliation:
Division of Neuro-Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
Mark Bernstein
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
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Abstract:

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Background:

Meningiomas of the anterior cranial fossa frequently present with impaired visual function. Recognition of this entity in the differential diagnosis of painless, progressive, and asymmetric optic neuropathy is important since reversal of visual loss is possible given timely surgical excision of the tumour.

Methods:

A 76-year-old man presented with no perception of light in his right eye and a reduced visual acuity of 20/60 in his left eye with a markedly constricted visual field. His visual deterioration had progressed over the previous three months and was not associated with headache. Ophthalmoscopy showed normal optic discs. MRI scanning showed a large frontal basal meningioma, which was subsequently resected.

Results:

The patient noticed an immediate improvement in his vision in his right eye. Visual acuity in his right eye improved to 20/50 at six weeks postoperatively and to 20/25 at five months, with corresponding improvement of the visual field.

Conclusion:

Complete monocular blindness due to tumour compressing or distorting the anterior visual pathways does not preclude recovery following timely decompressive surgery, especially when the appearance of the optic disc is normal.

Résumé:

RÉSUMÉ: Contexte:

Les méningiomes de la fosse antérieure se manifestent souvent par une altération de la vision. Il est important d’inclure cette entité dans le diagnostic différentiel de la neuropathie optique indolore, progressive et asymétrique, car la régression de la perte visuelle est possible si l’exérèse de la tumeur est faite à temps.

Méthodes:

Un patient âgé de 76 ans a consulté pour une absence de perception lumineuse au niveau de l’oeil droit et une acuité visuelle réduite à 20/60 au niveau de l’oeil gauche, accompagnée d’une constriction importante de son champ visuel. La détérioration de sa vision évoluait depuis trois mois et n’était pas associée à de la céphalée. L’ophtalmoscopie a montré des disques optiques normaux. À l’imagerie par résonance magnétique, on a découvert un gros méningiome basal frontal qui a été réséqué.

Résultats:

Le patient a constaté une amelioration immédiate de sa vision de l’oeil droit. L’acuité visuelle était de 20/50 six semaines après la chirurgie et de 20/25 cinq mois plus tard, avec une amélioration correspondante du champ visuel.

Conclusion:

Une cécité monoculaire complète due à une tumeur comprimant ou déformant les voies visuelles antérieures peut régresser après une décompression chirurgicale précoce, surtout quand le disque optique est d’apparence normale.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 1 , February 2003 , pp. 72 - 74
Copyright
Copyright © The Canadian Journal of Neurological 2003

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