A patient had bilateral superior altitudinal visual field defects because of radionecrosis of the inferior occipital lobes after gamma knife radiosurgery for a recurrent atypical cerebellar meningioma. Although radionecrosis of the anterior visual pathway has been well-documented, this is the first report of visual field loss associated with occipital lobe radionecrosis. The treatment dose this patient received is within the range of predicted tolerable radiosurgical dosing, although this patient was at increased risk for radionecrosis secondary to previous external beam radiotherapy. By offering an effective, noninvasive treatment, radiosurgery has changed the management of intracranial lesions. Radiosurgery targets a discrete volume of tissue and relatively spares the surrounding normal tissue. Radiation injury, or radionecrosis, is the only significant complication of radiosurgery (1). We present a case of bilateral occipital lobe radionecrosis after gamma knife surgery that resulted in bilateral superior altitudinal defects.