The patient was operated by me 26-November-2012 for left pterional meningioma with gross practical radical resection of the tumor. MRI done 20-March-2013 confirmed total resection of the tumor with sinusitis of the frontal area left side. The patient then came 02-December-2013, telling that she still having hyperlacrimation of the with slight edema of the lateral part of the superior wall of the orbit. The patient was sent for investigations and MRI done 02-December-2013 showing the sinusitis with a carpet of meningioma at the superior wall of the left orbit. The patient was advised to repeat investigations after 3 months. The patient then came 23-June-2014 with progression of the exophthalmus left eye and hyperlacrimation. The left pupil is reactive, but more wide than the right and she can see  with normal OMNs function. MRI done the same day showing considerable recurrence of the meningioma behind the left orbit and she was advised to undergo surgery for this mass. The patient disappeared and came came to the clinic 07-August-2019 telling that she is blind in the left eye for 4 years with pronounced left exophthalmus and decreased mobility of the eye movements to all directions. MRI performed 27-June-2019 showing small intradural compartment over the left frontal area and huge intraorbital tumor 52x33x25.6 mm pushing the globe downward with the optic nerve and other compartments involving the left ethmoidal area.

The patient was sent for cardio evaluation and new MRI performed 20-august-2019 ruling out involvement of the carotids.

Bifrontal craniotomy with reflection of the flap to the right ear. The frontal sinus was violated to obtain the most lower projection to the area avoiding by that traction injury to the brain. The dura was involved by the tumor at the left side, for what it was removed. The lateral and superior wall of the left orbit were dissected and removed in one block. It was tumorous and it was sent to boiling for 30 min to kill the intraossal tumoral components. A huge rubbery tumor was seen occupying the intraorbital superior part. Dissection of the tumor off the normal tissues with piece-meal resection. The left anterior clinoid was removed and the tumor was resected until no apparent tumor masses were seen. The old lyodura was free of any tumor. The tumor spread to the ethmoid sinuses were removed. A piece of muscle was embedded to the frontal sinus . It was impossible to water-tightly close the dura, for what 2 big pieces of lyodura were covered over both frontal lobes and covered by Surgicele. Some places were stitched using nylon 6 zero. Routine closure of the wound after stitching the bony elements with ready-Vac drain under the skin flap.

Smooth postoperative recovery. She was sent to the ICU.

The patient could move the eye to all directions and could feel the light after resolution of the ecchymosis.

The patient was discharged the 7th postoperative day. The histological result was that of meningothelial meningioma.

The tumor is increasing in size for what resection is preferable. She lost vision for 4 years and recovery of the vision is doubtful. At least for cosmetic appearance surgery was intimidated.