- Department of Neurosurgery, University of Messina, Italy
- Experimental Biomedicine and Clinical Neurosciences (BIONEC), Section of Neurosurgery, University of Palermo, Italy
- Department of Radiological Sciences, University of Messina, Italy
Department of Neurosurgery, University of Messina, Italy
DOI:10.4103/2152-7806.155256Copyright: © 2015 Alafaci C This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Alafaci C, Grasso G, Granata F, Cutugno M, Marino D, Salpietro FM, Tomasello F. Cavernous malformation of the optic chiasm: An uncommon location. Surg Neurol Int 16-Apr-2015;6:60
How to cite this URL: Alafaci C, Grasso G, Granata F, Cutugno M, Marino D, Salpietro FM, Tomasello F. Cavernous malformation of the optic chiasm: An uncommon location. Surg Neurol Int 16-Apr-2015;6:60. Available from: http://sni.wpengine.com/surgicalint_articles/cavernous-malformation-optic-chiasm-uncommon-location/
Background:Cavernous malformations (CMs) of the optic chiasm are rare lesions often presenting with acute chiasmal syndrome or a progressive visual loss. The case of a 48-year-old female with an intrachiasmatic CM is presented.
Case Description:The patient presented with an insidious history of progressive visual loss. Magnetic resonance imaging (MRI) showed a CM in the suprasellar region. The patient was operated via a right pterional approach with a complete lesion removal. The postoperative course was uneventful. Early postoperative ophthalmological examination revealed minimal improvement of the vision in the left eye.
Conclusion:The clinical, neuroradiological, and intraoperative findings are presented, along with a review of the literature.
Cavernomas, also known as cavernous angiomas or cavernous malformations (CMs), are vascular malformations characterized by the presence of sinusoid-like capillary vessels containing blood in a very sluggish circulation.[
CM involving cranial nerves is rarely reported. Optic nerve, third, seventh, and eight nerve in the internal auditory canal and seventh nerve in the temporal bone are rarely reported locations.[
We present a case of an opto-chiasmatic CM along with a pertinent review of the literature.
A 48-year-old female was admitted with a 6-month history of progressive decrease in the vision. At admission, the neurological examination showed bitemporal hemianopsia and a decreased pupillary reaction to light in both eyes. Fundus oculi examination showed a light papilla bilaterally. The patient did not complain of pituitary dysfunction.
Brain magnetic resonance imaging (MRI) showed a 2 cm hypointense lesion on T2-weighted images inside the optic chiasm in the suprasellar region. On T1-weighted images, the lesion appeared as an intraaxial lesion inside the optic chiasm without contrast enhancement after gadolinium administration [
Surgery was performed via a right pterional approach. The lesion was dissected out from arachnoid adherences and coagulated by using a quantum molecular resonance-based bipolar coagulation (Vesalius®). This device uses a relatively low temperature that does not exceed 45–50°C, having minimum effect on nervous tissues, nerves, and blood vessels. The cavernoma was shrunk and dissected out from the chiasma [
CMs of the optic chiasm are unusual lesions. The presenting symptoms range from progressive visual loss or pituitary disturbances to chiasmal apoplexy syndrome.[
Symptomatic CMs of the optic chiasm are generally treated surgically. Since these tumors are intrinsic lesions, a small nerve incision is required for excision. In such a case, a gliotic interspace between the vascular malformation and the surrounding normal tissue often provides a plane for a safe cleavage.[
However, other surgical approaches have been reported such as orbitozygomatic and subfrontal approaches[
The risk for recurrent hemorrhages and the good outcome following a complete resection suggest that CMs of the chiasm should be completely removed once diagnosed.
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