Giant 20/20 Meningioma: The Diagnostic Value of Confrontation Visual Fields

TL;DR

A rare case of a large frontal meningioma causing visual field loss is presented, emphasizing the importance of detailed eye exams in diagnosing brain tumors.

Contribution

Highlights the underappreciated role of confrontation visual field testing in diagnosing frontal meningiomas.

Findings

A giant frontal meningioma caused progressive visual field loss without behavioral changes.

Confrontation visual field testing was key in identifying the tumor despite normal visual acuity.

This case underscores the need for thorough ophthalmologic evaluations in suspected CNS tumors.

Abstract

Meningiomas are benign tumors of the central nervous system (CNS) that usually result in compression to adjacent structures and rarely cause pathology on their own. Meningiomas can affect the visual pathways originating from perineural or optic nerve sheath meningioma (ONSM), sellar, or clinoid, to the frontal-temporal-parietal-occipital lobes. Frontal meningiomas have an indolent presentation with frequent behavioral changes (i.e., personality or emotional changes, visual hallucinations), but they rarely present with visual disturbances. We present a case of a giant frontal meningioma causing progressive visual field loss despite preserved visual acuity and no behavioral changes. We aim to highlight the diagnostic value of performing a detailed ophthalmologic evaluation with confrontation visual field (CVF) testing and interpretation in aiding the discovery and diagnosis of intracranial tumors.

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