Sudden onset of complete ophthalmoplegia and blindness after resection of large frontal convexity meningioma: Case report

Background: Meningiomas are the most common benign intracranial tumors. Standard treatment of symptomatic meningiomas is microsurgical resection. Surgically, convexity meningiomas are simple to remove with low complication rate. This paper describes a rare and unexpected postoperative complication – orbital compartment syndrome, including blindness after convexity meningioma resection. We believe it to be caused by unintended interruption of atypical venous outflow route from the orbit which was formed due to meningioma presence. Case Description: We present the case of a 53-year-old woman with a history of approximately 10 years of cognitive impairment and worsening prefrontal syndrome. MRI scan revealed right-sided frontal convexity meningioma (7x6x6.5 cm) with significant expansive behaviour. The patient underwent microsurgical resection with no intraoperative complications. In the immediate postoperative period, there was a rapid development of orbital compartment syndrome: complete ophthalmoplegia, vision loss, periorbital edema, exophthalmos, and chemosis. Conclusions: Large frontal convexity meningiomas, long term clinically silent, can cause chronically increased intracranial pressure which may lead to the formation of alternative routes for venous drainage from the orbit. If such created veins run through diploe of cranium above the meningioma, they might be interrupted during the craniotomy, and this may result in orbital compartment syndrome. Awareness of this rare complication may help to avoid it, since treatment options are limited.