Background and Importance We present a case of a patient with a residual intraosseous
sphenoid wing meningioma presenting with
proptosis, orbital
pain, and monocular vision loss for 8 months who underwent
decompression of the optic canal, orbital contents, and orbital reconstruction resulting in significant improvement in her vision loss with full resolution of
proptosis and orbital
pain. Clinical Presentation A 43-year-old female presented with a 1 year history of
headache, peri-orbital
pain,
proptosis, and severe vision loss. She had previously undergone subtotal resection of a large Simpson Grade 1 spheno-orbital
meningioma 3 years prior at an outside institution. Workup at our institution revealed
hyperostosis of the left greater wing of the sphenoid bone and narrowing of the optic canal along with bony enhancement concerning for
residual tumor. The patient was given the recommendation from outside institutions for radiation, presumably due to the chronicity of her visual loss. Our institution recommended resection of the residual osseous
tumor with orbital reconstruction. Less than 2 weeks after surgery, the patient noted significant improvement in orbital
pain and vision. At 3 months, she had regained full and symmetric orbital appearance with no orbital
pain. Her visual acuity improved to 20/30 with full visual fields. Conclusion Surgical
decompression of the optic canal and orbital contents for
tumor related sphenoid wing
hyperostosis should be strongly considered, despite an extended duration of visual change and loss. This case report shows that vision can be significantly restored even after symptoms have been present for greater than 6 months.