Recurrence of Meningioma Following Surgery (Kennerdell Case 65, PPT)

History: The patient presented with a 2 mm left proptosis and chronic visual loss of the left eye to the level of 20/400 over a six month period. Anatomy: Orbit. Clinical: The visual field of the right eye was normal. The visual field of the left eye showed extensive inferior and central loss. The lesion having been removed under the operating microscope with sharpened blunt dissection with preservation of the dura of the Optic Nerve. There is a whitish irregular lesion and the inferior aspect shows the cavity which previously occupied the left Optic Nerve. The marked recovery of inferior field of vision in the left eye and the visual acuity recovered to 20/30. Disease Diagnosis: Meningioma. Neuroimaging: A ring-like lesion behind the left globe surrounding the Optic Nerve. The absence of the lesion with preservation of the Optic Nerve in the axial view of the left orbit with the lateral orbitotomy evident. The patient 11 years later with a continuing preservation of vision, but the axial MRI scan shows an unenhanced lesion medial and superior to the left Optic Nerve. The enlargement of the lesion with recurrent loss of vision in the left eye to 20/40, a slight visual field loss. The enhancing enlargement of the lesion 28 years following the first removal of the lesion with vision loss to the level of 20/60 and an inferior field defect. Presenting Symptom: 2 mm left proptosis and chronic visual loss of the left eye to the level of 20/400 over a six month period. Treatment: Lateral orbitotomy.