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A Right-Angle Optic Nerve with Normal Function Following Sphenoid Wing Meningioma Resection.

e124 Ophthal Plast Reconstr Surg, Vol. 32, No. 5, 2016 This is a 67-year-old female with a history of a WHO grade 1 left-sided skull base sphenoid wing meningioma invading the lateral orbital wall, greater wing of the sphenoid, and pterygopalatine space (Fig. 1). Preoperatively, left proptosis was evident, but there was no optic neuropathy. The patient underwent gross resection of the tumor via a left frontotemporal craniotomy with orbital zygomatic osteotomy and resection of the lesser and greater wing of sphenoid. The orbital roof and lateral wall were reconstructed with a porous polyethelyene orbitocranial prosthesis fixated with titanium plates. Approximately 1 year later, routine surveillance MR neuroimaging revealed a left-sided kinked optic nerve with an acute 90° angle bend secondary to enophthalmos and insufficient lateral support. Changes in the intraorbital connective tissue system as a result of loss of the posterior and lateral orbital wall could also contribute to the unusual nerve configuration (Fig. 2). Interestingly, these anatomic findings were not associated with optic neuropathy. Visual acuity was 20/20 and there was no afferent pupillary defect. On external exam, she has 5 mm of left enophthalmos and mild left infraduction limitation. The patient is considering an orbital volume implant for enophthalmos treatment.