J Cerebrovasc Endovasc Neurosurg.  2018 Sep;20(3):176-180. 10.7461/jcen.2018.20.3.176.

Cavernous Malformations at Optic Apparatus: Three Cases

• Kim HS
• Phi JH
• Kim JE
• Lee JY
• Kim SK
• Wang KC
• Cho WS

• KMID: 2422769
• DOI: http://doi.org/10.7461/jcen.2018.20.3.176

Abstract

Cavernous malformations (CMs) are angiographically occult vascular lesions, and their clinical presentations vary widely according to location of the lesion. Here, we reviewed three cases of CM located at the optic apparatus. All three patients experienced visual deterioration and underwent surgical resection. One achieved complete resection of the CM, whereas the others achieved subtotal resection. Visual symptoms of the two patients who achieved subtotal resection improved, but the visual symptom of the patient who achieved complete resection remained unchanged. One patient with subtotal resection presented postoperative improvement of visual symptoms but experienced deterioration in two years after surgical resection due to rebleeding from the remnant lesion, and he required a second operation. We recommend total resection of CM when feasible and regular follow-up after subtotal resection due to the risk of rebleeding.

Keyword

Cavernous hemangioma; Optic nerve; Surgery; Hemorrhage

MeSH Terms

Follow-Up Studies
Hemangioma, Cavernous
Hemorrhage
Humans
Optic Nerve

Figure

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  Fig. 1 Case 1. (A) Goldmann perimetry field test showing central scotoma on both eyes. (B) An axial computed tomography image showing the cavernous malformation located in the right suprasellar area. (C–E) Magnetic resonance images showing an approximately 1.5 cm-sized ovoid iso-intense lesion on T1-weighted images (C) and a hypointense lesion on T2-weighted (D) and T2* gradient-echo images (E) at the right suprasellar area. (F) Intra-operative photograph showing a CM embedded at the optic chiasm and optic nerve. (G) Pathological examination showing sinusoidal structures filled with hemorrhage, foamy macrophage infiltration, blood and fibrin clots (H&E stain, ×40).

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  Fig. 2 Case 2. (A) Goldmann perimetry field test showing right temporal hemianopsia on the right eye and central scotoma on the left eye. (B–D) Magnetic resonance images showing inverted V-shaped hemorrhage at the optic chiasm and the bilateral optic tracts on axial T2-weighted (B) and non-enhanced T1-weighted images (C, D). Honeycomb appearance with multi-stage bleeding is observed at the optic chiasm. (E) Intraoperative photograph with chocolate-colored tissue mixed with old blood. (F, G) Postoperative T2-weighted (F) and T1-weighted (G) images showing residual mass at the optic chiasm.

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  Fig. 3 Case 3. (A–C) Preoperative MR images showing a poorly enhanced lesion in the posteroinferior optic chiasm extending to the perimesencephalic cistern on T2-weighted (A) and enhanced T1-weighted (B, C) images. (D–F) Immediate postoperative MR image showing the partially resected lesion on T2-weighted (D) and enhanced T1-weighted (E, F). (G–I) Recurrent hemorrhage was identified on T2-weighted (G) and T1-weighted (H, I) MR images. MR = magnetic resonance.

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