BACKGROUND: Meningiomas are the most common benign intracranial neoplasms. Most are slow growing, but can progress to a large enough size to cause compression of adjacent structures. Treatment options for meningiomas include surgical excision, conventional radiotherapy, and gamma knife or linear accelerator radiosurgery.
CASE REPORT(S). A 72 year old white male with an ocular history of open angle glaucoma OU was recently diagnosed with a suprasellar meningioma compressing the left optic nerve. Visual symptoms included longstanding periocular discomfort OS. The patient explored treatment modalities for one year, and opted for a 6-week course of radiosurgery. One week prior to treatment, visual acuity was OD 20/20, OS 20/30. Visual field testing showed an arcuate scotoma OD and dramatic superior field loss approaching fixation, as well as an inferotemporal arcuate defect OS. Color vision was decreased OS, and a left APD was present. One week post-treatment, our patient reported an improvement in his peripheral vision OS, which was confirmed by objective visual field testing. Color vision had also improved in this eye.
CONCLUSIONS. The risks and benefits of available treatment modalities for meningiomas, along with factors such as patient’s age, medical history, tumor size and location must be carefully considered for each case. The goal is to maintain the patient’s quality of life and preserve visual function via surgical excision, conventional radiotherapy, or radiosurgery. Although our patient was told that radiosurgery would only arrest tumor growth and not shrink the tumor enough to decompress the optic pathways, he did experience a subjective and objective improvement in visual parameters. This report will discuss the pros and cons of each treatment modality and their effect on visual recovery.