This is a series of 30 patients diagnosed to have meningioma which is compressing the anterior visual pathway and causing visual deterioration, they have completed the follow-up period for 1 year; females represented 80% of patients included in this research.
Improvement in visual function was noticed in 73.3% of patients after surgical resection, and stationary course was recorded in 20% and deterioration of vision in 6.7% of patients which has a slight discrepancy from what Yasargil [6] and Ohata et al. [7] concluded, respectively, that improvement of vision was noted in 50% and 66%, while in 17% and 28% it remained unchanged and deterioration was noted in 10% and 25%.
The duration of symptoms before recognition of presence of tumors and starting preparation for surgery ranged between 2 and 24 months, which was shorter in tumors originating from locations immediately close to the optic canal and chiasm like diaphragma sellae, clinoidal, and tuberculum sellae meningiomas and longer duration in tumors originating from more distant areas like olfactory groove, planum sphenoidale, and sphenoid wing meningiomas, the duration of symptoms had no significant implication on the recovery of vision of our patients which is not matching the results of Schick and Hassler [5] who concluded in their study on surgical management of tuberculum sellae meningiomas that longer duration of preoperative symptoms correlated with worse recovery; also, Zevgaridis et al. [8] concluded “visual prognosis was favorably affected in patients duration of symptoms of less than seven months”. It may be the scope of study made the discrepancy between the Schick and Zevgaridis studies and this study as they focused only on the tuberculum sellae and anterior clinoid meningiomas which are of the nearest origin and rapidly eruptive tumors for vision deterioration according to our analysis.
In this study the tumor size and the site of origin had statistically non-significant impact on the postoperative results which are not matching the results of Schick and Hassler [5] which concluded that tumor size and location had effect on outcome.
In this study, from the analysis of patients’ age at the time of presentation, we noticed that patients at a lower age group are more favorably recovered concerning visual function (mean age 46.8 years) more than patients in higher age (56.6 years) group which matches the series by Zevgaridis et al. [8] “visual prognosis was favorably affected by age under 54 years,” and, according to Zevgaridis’ hypothesis, ischemia is the cause of primary visual loss rather than simply optic nerve compression, so younger patients are able to compensate for microvascular deprivation more effectively than older ones.
In this study, there is a substantial improvement in visual acuity in most of patients postoperatively especially in the groups with near-normal and moderate-low vision preoperatively; this improvement was most significant in the early postoperative period to 3 months follow-up visit; this improvement continued in further follow-up in less significant rate with also more prominent improvement in the better function group, the severe and profound low vision groups, and blindness group, as those with no perception of light NPL had non-significant improvement in the bad group with no improvement in the very bad group; these findings matches the results from Grkovic and Davidovic [9].
The statistical analysis of data in this study revealed important correlation between preoperative visual acuity status and vision improvement.
There is significant improvement in visual field over the time; the improvement was most significant in the first 6 months after surgery with slower and less significant improvement in the remaining time of the study.
In the follow-up evaluation of the visual field of the patient, there was a modest more affection in the visual field more than that in acuity in same patients, which may be due to unawareness of patients of field cuts as their central vision is not affected.
There is a significant improvement in visual field over time especially in the patients with better visual field evaluation preoperatively than those with worse values of visual field assessment preoperatively; also, improvement was more evident in the early postoperative period with more gradual improvement in following visits.
It was found a significant correlation between fundus examination status and postoperative recovery as those patients with just optic nerve head edema or no significant change in fundus on preoperative evaluation had the most significant and important improvement compared to groups with optic cupping or atrophy.