Cavernous Sinus Meningioma Presenting With Diplopia: A Case Report

Introduction Cavernous sinus is a dural venous sinus that contains internal carotid artery, the venous plexus, and cranial nerves. Vascular, inflammatory or neoplastic lesions can compress oculomotor nerve, trochlear nerve and abducens nerve causing impaired eye movements and diplopia [1]. Case Presentation A young woman presented with diplopia. Best corrected visual acuity (Snellen chart, Landolt C optotype) in the right eye (OD) was found to be 1.0 and 1.0 in the left eye (OS). She demonstrated impaired elevation of the left eye. On slit-lamp examination, the findings of the anterior pole were within normal limits. Optical coherence tomography showed slight retinal nerve fiber layer thickening bilaterally. Magnetic resonance imaging tomography revealed a left cavernous venous sinus meningioma (CSM). The patient was referred for neurosurgical treatment. Tactic of combination of subtotal meningioma resection followed by stereotactic radiosurgery to the remnant of the tumor was chosen. Discussion The cavernous sinus tumors are rare, accounting for less than 1% of all intracranial tumors [2]. Meningiomas are usually benign slowly growing tumors, but their evolution is unpredictable [3]. Diagnosis is based on symptoms and radiological findings [4]. Surgery and radiotherapy are the most common treatments for CSM [5]. Due to the high risk of severe complications, intracavernosal surgery is no longer the preferred treatment option, so radiotherapy is chosen as an alternative [6,7]. If patients with CMS can be treated initially with gamma knife therapy, better longterm tumor control and neurological outcomes are achieved [4]. Conclusions Cavernous sinus meningiomas can present with binocular diplopia. Implementing multimodal treatment options for these meningiomas can decrease risk of neurological complications, sustain better patient’s quality of life and achieve similar tumor control as radical surgery.