From Ophthalmology to Neurosurgery: an Unexpected Case in the Eye Emergency Room
Author: Alessandro Gaeta
Base Hospital / Institution: Department of internal Medicine and Medical Specialties (DIMI), Università di Genova, Italy
ePoster presentation
Abstract ID: 25-225
Purpose
To report a rare case of Primary Intraosseous Meningioma (PIM) presenting with orbital proptosis and visual symptoms, highlighting the ophthalmologist’s role in early detection and the importance of multidisciplinary surgical management for diagnosis and treatment.
Methods
A 44-year-old woman presented to the ophthalmic emergency department with unilateral proptosis, mild diplopia, and decreased visual acuity. Examination revealed conjunctival injection, afferent pupillary defect, severely decreased visual acuity and motility restriction. Humphrey 30-2 computerized visual field test (CVC) revealed profound reduction in sensitivity with peripheral sparing, while optical coherent tomography (OCT) showed preserved macular profile and retinal nerve fiber layer (RNFL) thickness. Cranio-orbital computed tomography (CT) and magnetic resonance imaging (MRI) showed a destructive bone lesion involving the left sphenoid and temporal bones, displacing the orbital structures. A multidisciplinary surgical team, including ophthalmic and maxillofacial surgeons, performed a targeted head biopsy through a supra-auricular arcuate incision, exposing the infratemporal fossa and temporal bone squama. Histology confirmed a WHO grade I Primary Intraosseous Meningioma.
Results
Following histological confirmation, surgical resection was planned. Neurosurgical intervention included a frontotemporal craniotomy with partial resection of the involved bone and orbital decompression to relieve the optic nerve. No postoperative complications occurred. The patient remains under multidisciplinary follow-up to monitor for recurrence and to determine the need for additional treatment.
Conclusion
This case highlights the crucial role of ophthalmologists not only in diagnosing skull base lesions but also in guiding therapeutic decisions. It further underscores the importance of close collaboration among ophthalmology, maxillofacial, and neurosurgery. Given its benign nature, prompt surgical intervention in PIM is critical to preserving function and preventing permanent visual loss.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Giovanni | Ottonelli | Humanitas Research Hospital |
| Alessandra | Di Maria | Humanitas Research Hospital |
| Costanza | Tredici | Humanitas Research Hospital |
