Anterior Clinoid Meningioma with Optic Chiasm Compression: Seven Years of Preserved Visual Function - A Case Report

Anterior clinoid meningiomas (ACMs) are surgically challenging skull base tumours arising in close proximity to the optic nerve, optic chiasm, and internal carotid artery. In asymptomatic patients, conservative management is well supported, yet the long-term neuro-ophthalmological course of conservatively managed ACMs with documented radiological optic pathway compression remains poorly characterized.

A 77-year-old woman was referred to neuro-ophthalmology following an incidental discovery of a right anterior clinoid mass. Magnetic resonance imaging (MRI) confirmed uniformly enhancing extra-axial mass compressing the optic chiasm and displacing the right optic nerve medially. She was asymptomatic with normal visual acuity, Humphrey visual field, and optical coherence tomography (OCT) at baseline. Conservative management was elected given her age, significant comorbidities, and absence of symptoms. Over 7 years of follow-up visits every 6 months, she remained visually asymptomatic with stable visual acuity, visual fields, and serial OCTs of the retinal nerve fibre layer and ganglion cell complex, both remaining above published thresholds associated with unfavourable visual outcomes in ACMs. Serial MRIs confirmed tumour stability throughout.

This case documents one of the longest reported periods of structured neuro-ophthalmological surveillance in a conservatively managed ACM with radiological chiasmal compression, demonstrating sustained preservation of visual function and structural optic nerve integrity over 7 years. Serial OCT should be integrated into the longitudinal surveillance of patients with ACMs when intervention is deferred.