Metastatic Glioblastoma to Intracranial Optic Nerves, Optic Chiasm and Optic Tracts

The patient with pathology confirmed glioblastoma after resectioning the superior frontal lobe tumor followed by 6 weeks of radiation therapy with concurrent temozolomide. The patient started bevacizumab to treat steroid-refractory vasogenic cerebral edema/radiation necrosis. 8 months after radiation therapy, he presented with bilateral, painless, and progressive decreased vision over one month. His exam was Light Perception vision in both eyes with mild bilateral temporal pallor. Orbital MRI, Axial and Coronal T1 Post Gadolinium and Fat Saturation showed Diffuse enlargement and enhancement of the intracranial optic nerves, optic chiasm, and optic tracts