Recently, the First Affiliated Hospital of PLA General Hospital (former 304 Hospital) neurosurgery department successfully removed a large intracranial saddle meningioma, and the patient recovered well and was recently discharged from the hospital. The patient, Li, 42 years old, had been treated for ophthalmologic disease and underwent glaucoma surgery twice at local hospitals due to blurred vision and visual field changes. After the surgery, his vision did not improve and gradually worsened. Later, further examination in other hospitals revealed that there was a tumor of 4 cm in diameter in the saddle area of *someone’s skull. Because of the large tumor and the high risk of surgery, the local hospital suggested the patient to go to the capital for medical treatment. So, the patient’s family came to the neurosurgery department of the First Affiliated Hospital of the PLA General Hospital after multiple inquiries and introduction from friends and relatives. When the patient came to the neurosurgery department of the First Affiliated Hospital of the PLA General Hospital, the vision of the right eye was only light perception and the vision of the left eye was on the verge of blindness (visual acuity 0.06). After a discussion among all the neurosurgeons of the hospital, it was concluded that the patient was suffering from an intracranial lesion of saddle area meningioma. Since the patient’s visual acuity was on the verge of blindness, it was thought that there was a high possibility of total blindness after surgery. In order to prevent further growth of the tumor, the patient should be operated aggressively and the tumor should be removed. The patient underwent craniotomy under general anesthesia, and the tumor was resected by pterygoid approach. We carefully resected the tumor in pieces under the microscope, separated the optic nerve from the tumor, and finally removed the tumor completely. Although the optic nerve was preserved intact during the surgery, the patient’s vision did not improve after the surgery because the tumor had been compressed for too long and the optic nerve was too damaged. Then some people may ask: Why would a brain tumor growing in the skull manifest as visual impairment? In fact, any cause of prolonged intracranial pressure increase can lead to visual impairment. The reason is that after prolonged intracranial pressure increase, it can gradually cause the pressure in the optic nerve sheath to rise and cause the patient’s optic nerve to atrophy, thus leading to vision loss. Patients who lack knowledge of neurosurgery are often first seen in ophthalmology for treatment of eye diseases. Because of the detailed medical subspecialties today, it is difficult to require a specialist to have comprehensive knowledge of the relevant, at this time, if the ophthalmologist does not timely related to the neurological examination, purely ophthalmic disease treatment, often difficult to receive significant therapeutic effect or even gradually aggravate the condition and delay treatment. Therefore, when the patient’s vision is poor and the ophthalmic treatment is ineffective, don’t forget to further investigate the nervous system to exclude the possibility of intracranial pathology. Many intracranial tumors are first seen in ophthalmology, and when they are found to have intracranial tumors and then referred to neurosurgery, most of the vision loss is more serious. Some intracranial lesions, such as pituitary tumors in the saddle area, saddle node meningioma, craniopharyngioma, optic nerve glioma, cranio-orbital communicating tumors, orbital tumors, and ophthalmic aneurysms, often have first symptoms of visual acuity and visual field changes in one or both eyes due to direct compression or destruction of the optic nerve by the lesion located in the saddle area. The nerve fibers located in the retinal optic cells of the fundus come together in bundles to form the optic nerve, which further enters the skull via the optic canal. These nerve fibers pass through the optic cross, optic bundle, optic radiation, and finally drop into the visual center of the occipital cerebral cortex. Any lesion such as tumor in any part of the above visual conduction pathway may lead to changes in the patient’s vision and visual field. Therefore, when patients have vision and visual field changes that are difficult to explain with ophthalmic knowledge, don’t forget to check the intracranial situation (e.g., cranial CT or MRI). These changes in vision and visual field due to intracranial lesions can generally be treated satisfactorily with timely surgery at an early stage. Like the patient mentioned at the beginning of the article, the visual impairment caused by intracranial lesions was already too heavy and too long at the time of consultation, so even if the lesions are surgically removed, the recovery of vision and visual field is hardly satisfactory.