Acute visual deterioration and headaches in a patient with suprasellar lesion: Question

Abstract

•Cavernous malformation should be a differential diagnosis of suprasellar lesions.•Management of asymptomatic optic apparatus cavernous malformation is still debatable.•The relative risk of visual deterioration after repetitive hemorrhage may be higher than the risk of surgical removal. A 62-year-old woman presented with a history of headaches for two weeks and sudden loss of vision in her left eye. Neurological examination revealed right eye acuity 6/6, left eye 6/9.5, left eye relative afferent pupillary defect (RAPD), red desaturation reduced in the same eye, confrontation visual fields showed non-congruent right homonymous hemianopia. Fundoscopy did not show any sign of papilledema or chronic optic atrophy (Fig. 1). There was no other focal neurological deficit [1Tan T. Tee J.W. Trost N. McKelvie P. Wang Y.Y. Anterior visual pathway cavernous malformations.J Clin Neurosci. 2015; 22: 258-267Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 2Moriarity J.L. Clatterbuck R.E. Rigamonti D. The natural history of cavernous malformations.Neurosurg Clin N Am. 1999; 10: 411-417Abstract Full Text PDF PubMed Google Scholar, 3Voznyak O. Lytvynenko A. Maydannyk O. Kalenska O. Hryniv N. Cavernous hemangioma of the chiasm and left optic nerve.Cureus. 2020; 12e8068PubMed Google Scholar, 4Hempelmann R.G. Mater E. Schröder F. Schön R. Complete resection of a cavernous haemangioma of the optic nerve, the chiasm, and the optic tract.Acta Neurochir (Wien). 2007; 149: 699-703Crossref PubMed Scopus (30) Google Scholar, 5Mano Y. Kumabe T. Saito R. Watanabe M. Tominaga T. Cavernous malformation of the optic pathway mimicking optic glioma: a case report.Childs Nerv Syst. 2014; 30: 1753-1758Crossref PubMed Scopus (7) Google Scholar, 6Hassler W. Zentner J. Wilhelm H. Cavernous angiomas of the anterior visual pathways.J Clin Neuroophthalmol. 1989; 9: 160-164PubMed Google Scholar, 7Liu J.K. Lu Y. Raslan A.M. Gultekin S.H. Delashaw J.B. Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature.Neurosurg Focus. 2010; 29: E17https://doi.org/10.3171/2010.5.FOCUS10129Crossref PubMed Scopus (48) Google Scholar, 8Crocker M. DeSouza R. King A. Connor S. Thomas N. Cavernous hemangioma of the optic chiasm: a surgical review.Skull Base. 2008; 18: 201-212Crossref PubMed Scopus (21) Google Scholar]. Head computer tomography (CT) with and without contrast revealed a hyperdense non enhanced suprasellar lesion closely related to the left optic chiasma. Brain magnetic resonance imaging (MRI) (Fig. 2) was performed (see Fig. 3).Fig. 3A) Intraoperative image of the left optic tract cavernoma removal (blue arrow) through a left pterional craniotomy, compressing the left optic nerve (red arrow) B) Intraoperative image after removal of the cavernoma, showing the left optic tract (blue star) and the optic chiasm (blue arrow head).View Large Image Figure ViewerDownload Hi-res image Download (PPT) a.Pituitary adenomab.Craniopharyngiomac.Optic nerve gliomad.Optic tract cavernoma Answer on page: 312 The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acute visual deterioration and headaches in a patient with suprasellar lesion: AnswerJournal of Clinical NeuroscienceVol. 86PreviewD. Optic tract cavernoma Full-Text PDF