Delayed Recovery of Visual Acuity after Sphenoorbital Meningioma Surgical Removal: Case Report and Review of the Literature. Is Visual Acuity Recovery Possible after an Initial Decline?

Piergiacomo Grassi; Diego Strianese; Giuseppe Mariniello; Giulio Bonavolontà

doi:10.1055/s-0034-1376191

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

J Neurol Surg A Cent Eur Neurosurg 2015; 76(04): 328-331
DOI: 10.1055/s-0034-1376191

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Delayed Recovery of Visual Acuity after Sphenoorbital Meningioma Surgical Removal: Case Report and Review of the Literature. Is Visual Acuity Recovery Possible after an Initial Decline?

Piergiacomo Grassi

¹Department of Neurosciences and Reproductive and Odontostomatologic Sciences, University of Naples “Federico II,” Orbital Unit, Naples, Italy

,

Diego Strianese

¹Department of Neurosciences and Reproductive and Odontostomatologic Sciences, University of Naples “Federico II,” Orbital Unit, Naples, Italy

,

Giuseppe Mariniello

²Department of Neurosciences and Reproductive and Odontostomatologic Sciences, University of Naples “Federico II,” Neurosurgery Unit, Naples, Italy

,

Giulio Bonavolontà

¹Department of Neurosciences and Reproductive and Odontostomatologic Sciences, University of Naples “Federico II,” Orbital Unit, Naples, Italy

› Institutsangaben

Abstract

Background and Study Aims To report a case of late recovery of visual acuity after surgical removal of a sphenoorbital meningioma (SOM).

Materials and Methods A 42-year-old woman was referred for progressive proptosis of the right eye for 5 years. Her best-corrected visual acuity (BCVA) was 10/10 in her right eye and 10/10 in her left eye, and thyroid function tests were negative. Ophthalmic examination showed slight exophthalmos of her right eye, but eye movements and pupillary light reflexes were normal. Intraocular pressure and fundus examination (FE) in both eyes were normal. Computed tomography scan of the orbits showed hyperostosis and an increase in the thickness of the lateral wall of the orbit, volume reduction of the right orbit, the optic canal, and the sphenoidal fissure, edema, and medial displacement of the lateral rectus muscle. We performed coronal orbitotomy and removed the tumor via a frontotemporal-orbitozygomatic approach and lateral orbitotomy.

Results Three hours postoperatively, her right eye was blind with signs of orbital apex syndrome. A high dose of intravenous corticosteroid was then administered. Twenty-four hours postoperatively, BCVA of right eye was motu manu (hand motion), and pupillary light reflexes in the right eye were absent. Five days postoperatively, BCVA allowed counting fingers at 5 m, and ocular motility was partially recovered. Fifteen days postoperatively, BCVA was 1/15, and eye movements were totally recovered. Eight months postoperatively, BCVA was 3/10, pupillary light reflexes were still absent, and FE in the right eye showed a slightly pale temporal half of the optic disc. Twenty months postoperatively, BCVA in the right eye was 7/10.

Conclusions Late recovery of visual acuity after sphenoorbital meningioma removal may be possible despite an initial decline.

Keywords

recovery of visual acuity - sphenoorbital meningioma - visual outcome

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Referenzen

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