Minimally Invasive Treatment of Cavernous Angioma of the Optic Chiasm: Case Report

Paladino, Josip; Rotim, Krešimir; Pirker, Ninoslav; Glunčić, Vicko; Jurić, Gordana; Kalauz, Miro

doi:10.1055/s-2001-16008

Cited by 20 publications

(7 citation statements)

References 4 publications

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“…A total of 64 OPH CM cases were identified. 2,[8][9][10][12][13][14][15]18,19,21,22,[25][26][27][29][30][31][36][37][38][39][40][41][42][46][47][48]51,52,[57][58][59][60][61][62][63][64]67,68 We also report an additional case in this paper, making a total of 65 cases that were reviewed. Each case was analyzed for clinical presentation, lesion location, radiographic features, surgical treatment, and neurological and visual outcome (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Liu

Lü

Raslan

et al. 2010

FOC

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Object Cavernous malformations (CMs) of the optic pathway and hypothalamus (OPH) are extremely rare. Patients with these lesions typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retroorbital pain, and nausea. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature for reported cases of OPH CMs to analyze clinical and radiographic presentations as well as surgical approaches and neurological outcomes. Methods A MEDLINE/PubMed search was performed, revealing 64 cases of OPH CMs. The authors report an additional case in the study, making a total of 65 cases. Each case was analyzed for clinical presentation, lesion location, radiographic features, treatment method, and visual outcome. Results In 65 patients with OPH CMs, the optic chiasm was affected in 54 cases, the optic nerve(s) in 35, the optic tract in 13, and the hypothalamus in 5. Loss of visual field and acuity was the most common presenting symptom (98%), followed by headache (60%). The onset of symptoms was acute in 58% of patients, subacute in 15%, and chronic progressive in 26%. Computed tomography scans revealed hyperdense suprasellar lesions, with calcification visible in 56% of cases. Magnetic resonance imaging typically demonstrated a heterogeneous lesion with mixed signal intensities suggestive of blood of different ages. The lesion was often surrounded by a peripheral rim of hypointensity on T2-weighted images in 60% of cases. Minimal or no enhancement occurred after the administration of gadolinium. Hemorrhage was reported in 82% of cases. Most patients were surgically treated (97%) using gross-total resection (60%), subtotal resection (6%), biopsy procedure alone (6%), biopsy procedure with decompression (23%), and biopsy procedure followed by radiation (2%). Those patients who underwent gross-total resection had the highest rate of visual improvement (85%). Two patients were treated conservatively, resulting in complete blindness in 1 patient and spontaneous recovery of vision in the other patient. Conclusions Cavernous malformations of the OPH are rare and challenging lesions. Gross-total resection of these lesions is associated with favorable visual outcomes. Emergent surgery is warranted in patients presenting with chiasmal apoplexy to prevent permanent damage to the visual pathway.

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Section: Methodsmentioning

confidence: 99%

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Liu

Lü

Raslan

et al. 2010

FOC

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“…1,3,19,25) Cavernous malformations involving the visual pathway are extremely rare, 1,6,8,9,16,20,23) with only 24 cases of cavernous angioma involving the optic nerve-chiasm complex. 5) Cavernous malformations in the sellar region can also arise from the adjacent brain and dura of the cavernous sinus.…”

Section: Discussionmentioning

confidence: 99%

“…Resection of cavernous malformations of the optic nerve-chiasm complex is also possible through an eyebrow keyhole. 20) However, complete removal of the lesion is essential because of the possibility of recurrence. 5) Recurrent lesions should also be treated surgically.…”

Section: Discussionmentioning

confidence: 99%

“…18) Optochiasmatic cavernous angioma is a very rare cause of visual symptoms and findings caused by optic nerve dysfunction. 1,6,8,9,16,20,23) Only a few neurosurgeons worldwide have experience with this type of suprasellar mass. Therefore, the diagnosis and treatment of cavernous angioma arising from the optic nerve-chiasm complex presents some problems.…”

Section: Introductionmentioning

confidence: 99%

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Optochiasmatic Cavernous Angioma: Unexpected Diagnosis-Case Report-

Özer

Kalemcı

Yücesoy

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 15-year-old boy presented with an extremely rare optochiasmatic cavernous angioma. He was admitted to a special hospital with the complaint of blurred vision persisting for 1 month. Magnetic resonance imaging and biopsy of the lesion were inconclusive. He was admitted to our neurosurgical clinic after worsening of the visual symptoms 9 months later. Repeat magnetic resonance imaging showed optochiasmatic cavernous angioma which had doubled in size. The lesion was removed completely without any problem. Postoperatively his visual complaints remained stable, but had improved after 1 year. Optochiasmatic cavernous malformation should be treated by surgical excision, whereas biopsy is useless and may result in enlargement.

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“…38 To date, 33 cases of CM of the optic pathways have been reported. [1][2][3][5][6][7][8][9][10][11][13][14][15][17][18][19][21][22][23][24][25][26][28][29][30][31][33][34][35][36][37][39][40][41] The majority of the cases is CM of the optic chiasm; in only seven cases, CM was located purely within the optic nerve. 5,7,9,19,24,31 ►Table 1 summarizes all reported cases on pure optic nerve CM.…”

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confidence: 99%

Surgery of Cavernous Hemangioma of the Optic Nerve: Case Report and Review

Ramina

Ebner

Ernemann

et al. 2012

J Neurol Surg A Cent Eur Neurosurg

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A case of a cavernous hemangioma of the optic nerve is presented. Cavernous malformations of the cranial nerves are quite rare and have been reported to involve the third nerve, the seventh nerve in the temporal bone, the seventh and the eighth nerves in the internal auditory canal as well as the optic chiasm and optic nerve. We present a case of a patient with a cavernous hemangioma within the right optic nerve, which could be removed by microsurgery with preservation and improvement of vision. Literature on this rare location of cavernoma is reviewed.

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Minimally Invasive Treatment of Cavernous Angioma of the Optic Chiasm: Case Report

Cited by 20 publications

References 4 publications

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Optochiasmatic Cavernous Angioma: Unexpected Diagnosis-Case Report-

Surgery of Cavernous Hemangioma of the Optic Nerve: Case Report and Review

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