Cavernous malformations affecting the optic chiasm are a rare cause of visual impairment. These low flow vascular lesions are associated with minor recurrent hemorrhage, and if this occurs in the optic chiasm, patients typically present with sudden onset of bitemporal hemianopia, retro-orbital headache, and nausea. 1 The majority of cases have extra-chiasmal involvement extending into the optic nerve or tract. 2 We present a case of chiasmal cavernous malformation, which demonstrates the challenges of clinical and radiologic diagnosis and surgical treatment.
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