J Cerebrovasc Endovasc Neurosurg.  2023 Dec;25(4):411-419. 10.7461/jcen.2023.E2023.01.003.

Optochiasmatic cavernoma: Surgical treatment and outcomes

• Konovalov A
• Saripov O
• Gadzhiagaev V
• Titov O
• Lasunin N
• Zhumabekov A
• Fomichev D
• Salvovich ES
• Kalinin P
• Chaurasia B

• KMID: 2549446
• DOI: http://doi.org/10.7461/jcen.2023.E2023.01.003

Abstract

Objective
Optochiasmatic cavernoma is an extremely rare cerebral lesion. They account for approximately 1% of all cavernomas of the central nervous system. Reports on this pathology are limited. Abrupt visual deterioration is a common symptom of the disease. Treatment strategy and visual outcomes after different treatment approaches remain a subject for discussion.
Methods
Patients operated in a period 2005-2021 were analyzed in this study. All patients preoperatively underwent computed tomography (CT) scan, CT-angiography, and magnetic resonance imaging (MRI). Visual function of the patients was assessed pre-op, post-op and at the follow-up. Duration of visual dysfunction was noted as well. Surgical details were also extracted from medical notes. All patients were followed up, and control MRI was performed one month after operation. We assessed surgical series of optochiasmatic cavernomas published for last 10 years. Further comparative analysis with our data was performed.
Results
Five patients were included into this study. There were four men and one woman. Mean age comprised 33.8 years (range 20-48 years). Most patients were admitted to our hospital due to visual disturbances (80%). Visual function improved in four patients. Visual function was unchanged in one patient, lacking visual disturbancies pre-op. Complication developed in one patient.
Conclusions
Optochiasmatic cavernomas are encountered extremely rare. Despite the use of contemporary diagnostic options, differential diagnosis remains challenging. Full diagnostic work-up is mandatory. After the diagnosis is made, surgical treatment should be considered first. Total microsurgical or endoscopic transsphenoidal removal of the optochiasmatic cavernoma is a relatively safe and effective treatment method facilitating improvement of visual function.

Keyword

Optochiasmatic cavernoma; Visual defect; Endoscopic endonasal surgery; Craniopharyngioma

Figure

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  Fig. 1. Schematic drawing demonstrating cavernoma location and applied surgical approach (microsurgical subfrontal and endoscopic transsphenoidal) in present series.

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  Fig. 2. Clinical case of endoscopic transnasal resection of the cavernoma of the chiasm and the third ventricle. (A) Chiasmatic lesion (arrow) extending to the third ventricle is shown on frontal T1-weighted contrast-enhanced images, (B) heterogeneous lesion (arrow) with post-hemorrhagic features on sagittal T1-weighted contrast-enhanced images, (C) CT scan 1 day post-op showing complete removal, (D) intraoperative endoscopic view, post-resection cavity and hematoma are depicted (arrow). CT, computed tomography; PComA, posterior communicating artery aneurysm

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  Fig. 3. Clinical case of microsurgical removal of a cavernoma of the left optic nerve. (A) Hypointentsive bulging of the left optic nerve (arrow) is visible on axial slices, T2WI, FIESTA, (B) heterogeneous, mostly isointensive zone in the region of the left optic nerve (arrow) on frontal slices, T2WI, (C) intraoperative view of a left-sided subfrontal approach, cavernoma (arrow) is easily recognizable in the left optic nerve, (D) post-resection cavity.

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  Fig. 4. Visual fields of a patient number 4. (A) Pre-op automatic perimetry showing a deficit in the lower part of the visual field of the right eye, (B) perimetry showing slight improvement of the visual field one-month post-op.

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