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A 29 year old woman with an unremarkable medical history presented with painless progressive visual failure in the left eye. On examination, the left eye was proptotic, with a visual acuity of 20/70, and a central scotoma. There was a left relative afferent pupillary defect, and mild papilloedema involving the left optic disc. The rest of the neurological examination was normal.
A sagittal T1 weighted gadolinium enhanced image showed a normal sized left optic nerve, concentrically surrounded by a homogeneously enhancing mass extending from the globe to the optic foramen (figure A).
At surgery, in keeping with the recommended principles of operative management for such lesions, the left optic nerve was sacrificed, and gross total resection of the tumour achieved, with clear margins. A longitudinal section through the operative specimen is shown (figure B, scale in cm).
Histopathological examination confirmed the clinical diagnosis of an optic nerve sheath meningioma (figure C, haematoxylin-eosin and luxol fast blue).