This case describes a G2P1 who presented at 34 weeks’ gestation with 17 weeks of visual deterioration. Outpatient cranial nerve examination revealed bilateral visual field defects. Urgent ophthalmological review and MRI revealed a Sphenoid Meningioma, which was compressing the pre-chiasm and optic chiasm. A decision for urgent resection was made as there was concern about progressive optic neuropathy. Following betamethasone loading, she had an elective caesarean section at 35 weeks’ gestation. She then proceeded to have an elective craniotomy and anterior fossa mengioma resection. Her post operative course was complicated by a frontal lobe contusion and seizures. The management of meningiomas in pregnancy is challenging. The physiological changes of pregnancy can alter the growth of meningiomas. A multi-disciplinary team approach, including Anaesthetic, Neurosurgical, Obstetric, Obstetric Medicine, and Ophthalmology input is required, to manage the complexity of these cases.