Visual disability rates in a ten-year cohort of patients with anterior visual pathway meningiomas

Purpose: To examine the visual outcome of anterior visual pathway meningioma (AVPM) patients followed for at least one year. Methods: Data were collected on demographics, clinical course and management. Visual disability was classified at the first and last examination as follows: I - no visual disability; II - mild visual defect in one eye; III - mild visual defect in both eyes; IV - loss of driver's license; V - legally blind. Results: Eight-one AVPM patients had their tumor originate in the clinoid process in 23 (28%), sphenoid-wing area in 18 (22%), cavernous sinus in 15 (19%), tuberculum sellae in 8 (10%), and mixed in 17 (21%). On last examination, 46 patients (57%) had good visual acuity in one or both eyes (Class I or II) and 17 (21%) were mildly affected in both eyes. The rate of Class IV disability was 16%, and Class V disability was 6%. Conclusions: Attention needs to be addressed to the considerable proportion of patients with AVPM (22% in this study) who may lose their driver's license or become legally blind. Occupational therapists should play an important role in the multidisciplinary management of those patients to help them adapt to their new physical and social situation.