Optic nerve meningioma

An obese white woman presented with a 10-month history of progressive loss of vision in the right eye associated with a moderate proptosis. Examination of the fundus revealed marked congestion of the retinal vasculature with dilation of both the arteries and the veins. Numerous blot hemorrhages were scattered throughout the retina. The retina was elevated and appeared to be displaced anteriorly by solid tissue, but B-scan ultrasonography demonstrated only a serous detachment of a thickened, markedly convoluted retina. A diagnosis of optic nerve meningioma was considered, but definitive treatment was deferred because of medical problems. One month later the patient returned with a blind, painful right eye associated with neovascular glaucoma. High resolution CT coronal sections of the orbit showed generalized thickening of the optic nerve. The blind eye was enucleated facilitating exposure of the optic nerve which was found to be diffusely thickened by meningioma. The orbital portion of the optic nerve was subsequently removed and meningioma was demonstrated along its entire length to the bony optic canal. A transfrontal craniotomy was later performed to rid the patient of residual tumor.