600 Section - Spheno-orbital Hemangiopericytoma Causing Total Blindness: Case Report Emphasizing Functional Rehabilitation and Recovery

Left Spheno-orbital Hemangiopericytoma

Case Description:

A 24-year-old woman presented with a 14-month history of progressive left temporoparietal headaches followed by bilateral visual blurring that progressed to complete blindness. Cranial MRI showed a T2-isointense, avidly enhancing extra-axial mass in the left middle cranial fossa producing significant mass effect. She underwent preoperative chemoembolization and left fronto-temporoparietal craniotomy. Histopathology confirmed a WHO grade 1 solitary fibrous tumor with STAT6 nuclear positivity.

Postoperatively, she remained bedbound with maximal dependence in ADLs, cognitive and communication deficits, dysphagia, involuntary movements and depressive symptoms. Intensive multidisciplinary rehabilitation was initiated. After three weeks, she showed marked gains in cardiopulmonary endurance, ambulation with walker and white cane, swallowing function, mood and ADL performance, with her Barthel Index improving from 25 to 80. Vision remained absent due to chronic papilledema.

Discussions:

Rehabilitation was essential to restoring function. Early, intensive, multidisciplinary programs have been shown to improve mobility, ADLs, cognition and psychosocial outcomes in CNS tumor survivors. This approach integrates mobility and endurance training, ADL retraining, cognitive rehabilitation, dysphagia management and psychological support - key components that were implemented in this case. For irreversible blindness, orientation and mobility training, sensory substitution and structured ADL modification promote safe, independent functioning. Cognitive rehabilitation effectively addresses parietal-lobe–related deficits, while swallowing therapy supports progression to safe oral intake. Psychological interventions are crucial in managing anxiety, depression and adjustment difficulties after neurosurgical disability. Her improvement from a Barthel Index of 25 to 95 by final follow-up demonstrates the transformative impact of structured, goal-oriented rehabilitation.

Conclusions: This case highlights the importance of comprehensive rehabilitation in managing spheno-orbital solitary fibrous tumors. Intensive multidisciplinary intervention significantly improved mobility, strength, ADLs, cognition, emotional well-being, and adaptation to permanent blindness. Long-term follow-up remains essential for monitoring recurrence and sustaining functional gains.